IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DIS TRICT OF ALABAMA [] DIVISION [] ) ) Plaintiff (s) , ) ) v. ) CIVIL ACTION NO.: [] ) [] ) ) Defendant ( s ) . ) CONSENT TO JURISDICTION BY A UNITED STATES MAGISTRATE JUDGE In accordance with the provisions of Title 28, U.S.C. 244 636(c), the undersigned party or parties to the above - captioned civil matter hereby confirm in writing their consent to a United States Magistrate Judge 325 s conducting any and all further proceedings in the case, including trial, and ordering the entry of a final judgment. Date Signature Counsel For ( print name of party or parties) Address, City, State , Zip Code Telephone Number Return form to: Debra Hackett, Clerk, United States District Court for the Middle District of Alabama, Montgomery, Alabama 3610 DO NOT FILE THIS FORM ELECTRONICALLY American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT OF THE UNITED STATES FOR THE MIDDLE DISTRICT OF ALABAMA EXPLANATION OF ASSIGNMENT TO UNITED STATES MAGISTRATE JUDGE In accordance with 28 U.S.C. 244 636(c), the Magistrate Judges of this court are designated to conduct any and all proceedings in a jury or nonjury civil case and order the entry of final judgment upon the consent of all parties to a case. Any appeal from a judgment entered by a Magistrate Judge is taken directly to the Unit ed States Court of Appeals for the Eleventh Circuit in the same manner as any appeal from any judgment entered in this court. Any party to this lawsuit has the right to consent or decline consent to the jurisdiction of a Magistrate Judge. To exercise you r right to consent you should complete the consent form and return it to the Clerk of the Court as indicated in the court's order. Litigants, without concern for any adverse consequences, freely may decline consent to the jurisdiction of a Magistrate Judg e. If you decline consent to the jurisdiction of a Magistrate Judge, this case will remain assigned to the District Judge. American LegalNet, Inc. www.FormsWorkFlow.com