AO 85 (Rev. locally 5/99) Notice, Consent, and Order of Reference – Exercise of Jurisdiction by a United States Magistrate Judge UNITED STATES DISTRICT COURT Middle District of Florida _____________________________________, Plaintiff(s) v. Case Number: _____________________________________, Defendant(s) N OTICE OF A VAILABILITY OF A U NITED STATES MAGISTRATE JUDGE TO EXERCISE JURISDICTION In accordance with the provisions of 28 U.S.C. 636(c) and Fed.R.Civ.P. 73, you are hereby notified that a United States Magistrate Judge of this District Court is available to conduct any or all proceedings in this case, including a jury or bench trial, and to order the entry of a final judgment. Exercise of this jurisdiction by a Magistrate Judge is, however, permitted only if all parties voluntarily consent, as evidenced by execution of the Consent portion hereof, all together on this form, to the exercise of jurisdiction by a United States Magistrate Judge. You may, without adverse substantive consequences, withhold your consent; but this will prevent the Court's jurisdiction from being exercised by a Magistrate Judge. If any party withholds consent, the identity of the parties consenting or withholding consent will not be communicated to any Magistrate Judge or to the District Judge to whom the case has been assigned. Appeal from a judgment entered by a Magistrate Judge shall be taken directly to the United States Court of Appeals for the Eleventh Circuit, in the same manner as an appeal from any other judgment of this District Court. C ONSENT TO THE EXERCISE OF JURISDICTION BY A U NITED STATES MAGISTRATE JUDGE In accordance with the provisions of 28 U.S.C. 636(c) and Fed.R.Civ.P. 73, the parties in this case hereby voluntarily consent to have a United States Magistrate Judge conduct any and all further proceedings in the case, including the trial; order the entry of a final judgment; and conduct all post-judgment proceedings, as necessary. Signatures Party Represented Date Signed ORDER OF R EFERENCE IT IS HEREBY ORDERED that this case be referred to Honorable_______________________________________________, United States Magistrate Judge, for all further proceedings and the entry of judgment in accordance with 28 U.S.C. 636(c), Fed.R.Civ.P. 73, and the foregoing consent of the parties. Date JOHN E. STEELE, United States District Judge NOTE: RETURN THIS FORM TO CLERK OF COURT ONLY IF ALL PARTIES HAVE SIGNED ON THIS FORM CONSENTING TO EXERCISE OF JURISDICTION BY A MAGISTRATE JUDGE. American LegalNet, Inc. www.FormsWorkflow.com