UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND __________________________________, Plaintiff(s) v. __________________________________, Defendant(s) : : : : : : : : Case No. _______________________ NOTICE TO PARTIES OF RIGHT TO CONSENT TO JURISDICTION OF A UNITED STATES MAGISTRATE JUDGE In accordance with the provisions of Title 28, U.S.C. Sec. 636(c), and Fed.R.Civ.P. 73, you are hereby notified that a United States Magistrate Judge of this Court is available to exercise the Court's jurisdiction and to conduct any or all proceedings in this case including a jury or nonjury trial, and entry of a final judgment. Exercise of this jurisdiction by a magistrate judge is permitted only if all parties voluntarily consent. You may consent to have your case referred to a magistrate judge, or you may withhold your consent without adverse substantive consequences. The name of any party consenting or withholding consent will not be revealed to any judge who may otherwise be involved with your case. An appeal from a judgment entered by a magistrate judge may be taken directly to the United States Court of Appeals for the First Circuit in the same manner as an appeal from any other judgment of a district court. If you desire to consent to this action please indicate by signing below and returning the form to the Clerk's Office within 30 days from the date of this Notice. Name Signature (type "/s/" and your name) Counsel for Date COMPLETE THIS FORM AND CLICK THE E-MAIL BUTTON TO SEND IT TO THE CLERK'S OFFICE VIA YOUR EMAIL PROVIDER. YOU MAY ALSO SAVE THIS FORM AND ATTACH IT TO AN EMAIL AND SEND IT TO: RID_CONSENT@RID.USCOURTS.GOV. American LegalNet, Inc. www.FormsWorkFlow.com