NAME, ADDRESS & TELEPHONE NUMBER OF ATTORNEY(S) FOR, OR, PLAINTIFF OR DEFENDANT IF PLAINTIFF OR DEFENDANT IS PRO PER ATTORNEYS FOR: UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER: Plaintiff(s), v. STATEMENT OF CONSENT TO PROCEED BEFORE ASSIGNED UNITED STATES MAGISTRATE JUDGE PURSUANT TO TITLE 28 U.S.C. § 636(c) (For use in Report and Recommendation Cases only) Defendant(s) (THIS FORM SHALL BE USED ONLY FOR CASES IN WHICH A CASE HAS BEEN ASSIGNED TO A DISTRICT JUDGE AND REFERRED TO A MAGISTRATE JUDGE FOR A REPORT AND RECOMMENDATION. (NOTE: PARTIES IN HABEAS CASES SHOULD USE FORM CV-11B) I. NOTICE REGARDING CONSENT TO THE ASSIGNED MAGISTRATE JUDGE PURSUANT TO LOCAL RULE 73-3 1. 2. Approval by the assigned District Judge is not required for cases referred to the Magistrate Judge for a Report and Recommendation. 3. Parties are free to withhold consent to magistrate judge jurisdiction without adverse substantive consequences. 4. II. In accordance with the provisions of 28 U.S.C. § 636 (c), all parties may consent to the assigned Magistrate Judge to conduct all further proceedings, including jury or non-jury trial (if applicable), and entry of final Judgment, by executing and filing a joint (or separate) statement(s) of consent, setting forth such election. If all parties consent to the jurisdiction of the assigned Magistrate Judge, any appeal would be made directly to the United States Court of Appeals. CONSENT TO THE ASSIGNED MAGISTRATE JUDGE I voluntarily consent to have the assigned United States Magistrate Judge conduct all further proceedings in this case, including a trial (if applicable), and order the entry of final Judgment. Name of Counsel OR Party if Pro Per Signature and date Counsel for (Name Parties) NOTICE TO COUNSEL FROM CLERK All parties having consented to proceed before the assigned magistrate judge, this case has been reassigned to United States Magistrate Judge ___________________________for all further proceedings. Please use the case number on all documents subsequently filed to ensure the proper routing of all filings. CV-11 (06/09) STATEMENT OF CONSENT TO PROCEED BEFORE ASSIGNED UNITED STATES MAGISTRATE JUDGE PURSUANT American LegalNet, Inc. TO TITLE 28 U.S.C. § 636(c) (For use in Report and Recommendation Cases) www.FormsWorkFlow.com