1 2 3 4 5 6 7 8 9 10 11 12 United States District Court Northern District of California 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA Case No. C Plaintiff(s) v. CONSENT OR DECLINATION TO MAGISTRATE JUDGE JURISDICTION Defendant(s). INSTRUCTIONS: Please indicate below by checking one of the two boxes whether you (if you are the party) or the party you represent (if you are an attorney in the case) choose(s) to consent or decline magistrate judge jurisdiction in this matter. Sign this form below your selection. Consent to Magistrate Judge Jurisdiction In accordance with the provisions of 28 U.S.C. § 636(c), I voluntarily consent to have a United States magistrate judge conduct all further proceedings in this case, including trial and entry of final judgment. I understand that appeal from the judgment shall be taken directly to the United States Court of Appeals for the Ninth Circuit. OR Decline Magistrate Judge Jurisdiction In accordance with the provisions of 28 U.S.C. § 636(c), I decline to have a United States magistrate judge conduct all further proceedings in this case and I hereby request that this case be reassigned to a United States district judge. DATE: ________________ NAME: COUNSEL FOR (OR "PRO SE"): Signature