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. Defendant(s) STATEMENT OF CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGE PURSUANT TO TITLE 28 U.S.C. § 636(c) (For use in Report and Recommendation Cases Only) THIS FORM SHALL BE USED ONLY IN CASES THAT HAVE 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 A MAGISTRATE JUDGE PURSUANT TO LOCAL RULE 73-3 1. In accordance with the provisions of 28 U.S.C. § 636(c), all parties may consent to a 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. Approval by the assigned District Judge is not required for cases referred to a Magistrate Judge for a Report and Recommendation. Parties are free to withhold consent to Magistrate Judge jurisdiction without adverse substantive consequences. If all parties consent to the jurisdiction of a Magistrate Judge, any appeal would be made directly to the United States Court of Appeals. 2. 3. 4. II. CONSENT TO A MAGISTRATE JUDGE I voluntarily consent to have a 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 Se Signature and date Counsel for (Name Parties) STATEMENT OF CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGE PURSUANT TO TITLE 28 U.S.C. § 636(c) (For Use in Report and Recommendation Cases Only) CV-11 (05/16) American LegalNet, Inc. www.FormsWorkFlow.com