UNITED STATES DISTRICT COURT EASTE RN DISTR ICT OF VIR GINIA ____________________ DIVISION ____________________________________ Plaintiff vs. Case Number: _______________________ ____________________________________ Defendant CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGE In accordance with the provisions of 28 U.S.C. § 636(c) and Federal Rule Civil Procedure 73, the parties in this case hereby voluntarily waive their right to proceed before a United States district judge and consent to have a United States magistrate judge conduct any and all further proceedings in the case, including the trial, and order the entry of final judgment. ____________________________________ Plaintiff’s signature _______________________ Date signed ____________________________________ Plaintiff’s counsel’s signature _______________________ Date signed ____________________________________ Defendant’s signature _______________________ Date signed ____________________________________ Defendant’s counsel’s signature _______________________ Date signed NOTICE OF OPPORTU NITY TO CONSENT TO EXERCISE OF CIVIL JURISDICTION BY UNITED STATES MAGISTRATE JUDGE In accordance with provisions of 28 U.S.C. § 636(c) and Federal Rule Civil Procedure 73, you are notified that the United States magistrate judges of this court, upon the consent of the parties in a civil case, may conduct any and all proceedings in the case, including a jury or non-jury trial, and order the entry of a final judgment. Any appeal shall be taken to the United States court of appeals, in accordance with 28 U.S.C. §636(c), as amended. If a party agrees to the exercise of civil jurisdiction by a United States magistrate judge, that party should execute and file, either jointly or separately, this consent form. Your decision to consent, or not to consent, to the referral of your case to a United States magistrate judge for dispositio n is voluntary. You are free to withh old consent withou t adverse substantive conseque nces. No di strict judge o r magistrat e judge wil l be inform ed of a party's response to this notification unless all parties have consented to the referral of the case to a magistrate judge. 2002 © American LegalNet, Inc.