UNITED STATES DISTRICT COURT FOR THE DISTRICT OF WYOMING Plaintiff vs Case Number: Defendant NOTICE OF ASSIGNMENT TO A UNITED STATES MAGISTRATE JUDGE AND CONSENT/REQUEST FOR REASSIGNMENT In accordance with United States District Court for the District of Wyoming Administrative General Order 2014-03, and Fed.R.Civ.P. 73, you are notified that the above entitled action has been assigned to a United States Magistrate Judge to conduct all proceedings in this case, including trial, entry of final judgment, and all post-judgment proceedings. Exercise of this jurisdiction by a United States Magistrate Judge is permitted only if all parties file a written consent. Indicate below if you consent to the assignment or request the case be reassigned to a District Court Judge. Consent Reassignment Party(s) represented Party(s) represented Attorney Signature Date Attorney Signature Date You are required to return this form to the Clerk's Office within fourteen (14) days from the filing of an answer or otherwise responsive pleading (i.e. a motion to dismiss). After completing this form, counsel are required to e-mail this completed form in pdf format by emailing it to: consents@wyd.uscourts.gov. Alternatively, the form may be mailed to the following address: U.S. District Court, 2120 Capitol Avenue, Room 2131, Attention: Consent Clerk , Cheyenne, Wyoming 82001. Do not e-file this document. No Judge will be informed of a party's response to this notification, unless all parties have consented to the assignment of the matter to a United States Magistrate Judge. An appeal from a judgment entered by a United States Magistrate Judge will be made directly to the United States Circuit Court of Appeals for the Tenth Circuit in the same manner as an appeal from any other judgment of this district. 28 U.S.C. § 636(c); Fed.R.Civ.P. 73. WY 39 Rev. 10/10/2014 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com