UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS Consent to Exercise of Jurisdiction By a United States Magistrate Judge Case Title: Case Number: Assigned Judge: V. Designated Magistrate Judge: In accordance with the provisions of Title 28 U.S.C. §636(c), the undersigned party or parties to the above-captioned civil matter hereby voluntarily consent to have a United States Magistrate Judge conduct any and all further proceedings in this case, including trial, and order the entry of a final judgment. Should this case be reassigned to a magistrate judge other than the magistrate judge designated pursuant to Local Rule 72.1, the undersigned may object within 21 days of such reassignment. If a timely objection is filed by any party, the case will be reassigned to the district judge before whom it was last pending. If no objection has been filed within 21 days, the parties will be deemed to have consented to the reassignment. __________ Date __________ Date __________ Date __________ Date By:______________________ ______________________________ Signature Name of Party or Parties By:______________________ ______________________________ Signature Name of Party or Parties By:______________________ ______________________________ Signature Name of Party or Parties By:______________________ ______________________________ Signature Name of Party or Parties Note: File this consent only if all parties have consented on this form to the exercise of jurisdiction by a United States magistrate judge. American LegalNet, Inc. www.FormsWorkFlow.com