IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF NORTH CAROLINA ) ) Plaintiff, ) ) v. ) Docket No. _______________ ) ) ) Defendant. ) CONSENT TO JURISDICTION BY A UNITED STATES MAGIS TRATE 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 the case, including trial, entry of a final judgment, and ruling on post-judgment matters. An appeal from a judgment entered by a magistrate judge shall be taken directly to the United States court of appeals for this judicial circuit in the same manner as any appeal from any other judgment of a district court. Date Signature Date Signature NOTE : Return this form to the Clerk of the Court if you consent to jurisdicti on by a magistrate judge. Do not send a copy of this form to any district judge or magistrate judge. American LegalNet, Inc. www.USCourtForms.com