Free Complaint - District Court of Delaware - Delaware

Case 1:05-cv-00220-SLR Document 1-5 Filed 04/14/2005 Page 1 of 1
AO FORM 85 RECEIPT (REV. 9/O4!
United States District C0urt for the District of Delaware
Civil Action N0. _ _
ACKNOWLEDGMENT
OF RECEIPT FOR AO FORM 85
NOTICE OFA VAILABILITY OFA
UNITED STATES MAGISTRATE JUDGE
TO EXERCISE JURISDICTION
I HEREBY ACKNOWLEDGE RECEIPT OF Q COPIES OF AO FORM 85.
(Date igorms ISSIICCTB (Signa r of Partyieritheir R presentative)
. Dr/i/1·//IRIN @,0 __: g -A
(Printed name of Party 0r their Representative)
Note: Comgleted receigt will be filed in the Civil Action