UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS Limited 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 certain specific proceedings in this case, allowing for the magistrate judge to exercise the court’jurisdiction to conduct any and all proceedings, including the entry s of final judgment, as to the following motion(s): Description Date Filed ____________ Date By:______________________ ______________________________ Signature Name of Party or Parties ____________ Date By:______________________ ______________________________ Signature Name of Party or Parties ____________ Date By:______________________ ______________________________ Signature Name of Party or Parties ____________ Date 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. Should this case be reassigned to a magistrate judge other than the magistrate judge designated pursuant to Local Rule 72, the undersigned may object within 30 days of such reassignment. If an objection is filed by any party, the case will be reassigned to the district judge before whom it was last pending. American LegalNet, Inc. www.USCourtForms.com