Case 1:05-cv—00879-SLR Document 1-3 Filed 12/20/2005 Page 1 of 1
AO FORM 85 RECEIPT (REV. 9/O4! I
United States District Court for the District of Delaware
Civil Action No. G TA {T T 9
ACKN OWLED GMENT
OF RECEIPT FOR AO FORM 85
NOTICE OF A VAILABILI T Y OF A
UNITED STA TES MAGIIHTRATE JUDGE
TO EXERCISE JURISDICTION
I HEREBY ACKNOWLEDGE RECEIPT OF T COPIES OF AO FORM 85.
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) l (Date forms issued) (Signature of Party or eir epresentative)
‘ E(Printed name of Party or their Representative) `
Note: Corngleted receipt will be tiled in the Civil Action