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CV-11D (1/19) STATEMENT OF CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGEPage 1 of 2(For use in Reassignment of Civil Cases to United States Magistrate Judges on Voluntary Consent List only) NAME & CONTACT INFORMATION REQUIRED BY L.R. 11-3.8 OF ATTORNEY(S) OR PRO PER:ATTORNEY(S) FOR:UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIAPlaintiff(s)v.Defendant(s)CASE NUMBER: CV STATEMENT OF CONSENT TO PROCEED BEFORE AUNITED STATES MAGISTRATE JUDGE(For use in Reassignment of Civil Cases to United StatesMagistrate Judges on Voluntary Consent List only)(THIS FORM SHALL BE USED ONLY FOR CASES IN WHICH ALL PARTIES CONSENT TO A VOLUNTARY CONSENT LIST MAGISTRATE JUDGE PURSUANT TO GENERAL ORDER NO. 18-11) The parties signing below acknowledge the following: As provided in General Order No. 18-11, the parties may select any Magistrate Judge from the Voluntary Consent List maintained by the Clerk of Court to conduct all further proceedings in this case, pursuant to 28 U.S.C. 247 636(c) and F.R.Civ.P. 73(b), if ALL PARTIES consent to the jurisdiction of that Magistrate Judge. Consent to proceed before a Magistrate Judge may be withheld by any party without any adverse consequences. If a case is reassigned to a Magistrate Judge pursuant to General Order No. 18-11, any appeal from a judgment of that Magistrate Judge shall be taken to the United States Court of Appeals in the same manner as an appeal from any other judgment of the District Court, in accordance with 28 U.S.C. 247 636(c)(3).The undersigned party or parties hereby voluntarily consent to have the following United States Magistrate Judge, chosen from the Voluntary Consent List maintained by the Clerk of Court, conduct all further proceedings in this case, including trial and final judgment: [insert name of selected United States Magistrate Judge]Name of Counsel (OR Party if Pro Per)Signature and dateCounsel for (Name of Party or Parties)GParty lodging this form shall check this box to confirm that ALL PARTIES have consented to proceed before theselected Magistrate Judge. Please note:Unless the case or filing party is exempt from electronic filing, this completed form must be electronically filed as an attachment to a Notice of Lodging, as required by Local Rule 5-4.4; after the written consent of all parties has been submitted to the Court, this completed form must be e-mailed to the assigned District Judge222s generic chambers e-mail address using the CM/ECF System. If the case or filing party is exempt from electronic filing, the written consent of all parties may be lodged with the Clerk in paper form pursuant to Local Rule 5-1. American LegalNet, Inc. www.FormsWorkFlow.com CV-11D (1/19) STATEMENT OF CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGEPage 2 of 2(For use in Reassignment of Civil Cases to United States Magistrate Judges on Voluntary Consent List only) APPROVAL or DENIAL BY DISTRICT JUDGEThe written consent of all parties to proceed before a United States Magistrate Judge to conduct all further proceedings ishereby G APPROVED G DENIED:DateUnited States District JudgeAPPROVAL or DENIAL BY MAGISTRATE JUDGEThe written consent of all parties to proceed before a United States Magistrate Judge to conduct all further proceedings ishereby G APPROVED G DENIED: DateUnited States Magistrate JudgeNOTICE TO COUNSEL FROM CLERK:G All parties having consented to proceed before the selected Magistrate Judge, and the parties222 consent having beenapproved by both the District Judge and the Magistrate Judge, this case is hereby reassigned to Magistrate Judge for all further proceedings, pursuant to General Order No. 18-11.Please use the case number on all documents subsequently filed in this case.G The District Judge or Magistrate Judge having denied the consent of all parties to proceed before a Magistrate Judge,this case shall remain assigned to the District Judge. American LegalNet, Inc. www.FormsWorkFlow.com