Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv-00887-GI\/IS Document 1-4 Filed 12/23/2005 Page 1 of 1
AO rom ss iuscrm guzv, 9/042
United States District Court for the District of Delaware
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Civil Action No.
ACKN O WLED GMENT
OF RECEIPT FOR AO FORM 85
NOTICE OFA VAILABILITY OFA
UNITED STATES MAGISTRATE JUDGE
TO EXERCISE JURISDICTION
I HEREBY ACKNOWLEDGE RECEIPT OF (95 COPIES OF AO FORM 85.
_ l (Date forms issued) (Sign of Party or their Represe tive)
is iti @12 frei-
Q ;fPrinted name ofPa11y or their Representative) I
Note: Corngleted recei t will be tiled in the Civil Action