Free Consent to Jurisdiction by US Magistrate Judge - District Court of Connecticut - Connecticut

‘ _ _· Case 3:03-cv-00978-HBF Document 18 Filed 10/15/2004 Page1 of 2
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UNITED STATES DISTRICT COURT mm ?DG¤POP£f ,
DISTRICT OF CONNECTICUT /29 /CfE22ii~4»RB—— i
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Carol Drown : T
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v. : Civ. 3:03cv978 WWE (HOF\ I
TFC Conway #1346 :
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CONSENT TO JURISDICTION BY A UNITED STATES MAGISTRATE JUDGE
In accordance with the provisions of Title 28, United States `
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Code, Section 636(c), the undersigned party or parties to the i
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above—captioned civil matter hereby voluntarily consent to have a \
United States Magistrate Judge conduct any and all further R
proceedings in the case, including trial, and order the entry of a I
final judgment.
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Signature Party Repres d Date
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Signature Party Represented Date \
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Signature hh Party Represented Date
Signature —— Party Represented Date
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RETURN THIS FORM TO THE CLERK OF THE COURT IF YOU CONSENT TO
JURISDICTION BY MAGISTRATE JUDGE. DO NOT SEND A COPY OF THIS FORM T
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TO ANY DISTRICT JUDGE OR MAGISTRATE JUDGE. I
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I ORDER OF REFERENCE I
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IT IS HEREBY` ORDERED that this case be referred to the I
Honorable Holly Fitzsimmons , United States I
Magistrate Judge, for all further proceedings and the entry of I
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judgment in accordance with 28 U.S.C. 636(c), Fed.R.C1v.P. 73 and
the foregoing consent of the parties. I
10-15-04 *·. r I I g
Date Senior United States District Judge · I
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