Case 2:11-cv-01426-MHB Document 4-1

Filed 07/18/11 Page 1 of 1

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(FOR USE IN CIVIL CASES WITH MAGISTRATE JUDGE AS PRESIDER)

RETURN THIS FORM TO THE CLERK'S OFFICE NOT LATER THAN FOURTEEN (14) DAYS FROM YOUR APPEARANCE IN THIS CASE. Do NOT electronically file this document! IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA ) ) ) ) ) ) ) ) ) )

Plaintiff,

Case No. ______________

Defendant.

CONSENT TO EXERCISE OF JURISDICTION BY UNITED STATES MAGISTRATE JUDGE In accordance with provisions of Title 28, U.S.C. Sec. 636(c)(1), the undersigned (party)(counsel of record for ___________________________) in the above-captioned civil matter hereby voluntarily consents to have a United States Magistrate Judge conduct any and all further proceedings in the case, including trial and entry of a final judgment, with direct review by the Ninth Circuit of Appeals if an appeal is filed. Date: _______________________ _________________________________ Signature

_________________________________ Print Name ========================================================= DISTRICT JUDGE OPTION Pursuant to Title 28, U.S.C. Sec. 636(c)(2) the undersigned (party)(counsel of record for ___________________________) in the above captioned civil matter acknowledges the availability of a United States Magistrate Judge but elects to have this case randomly assigned to a United States District Judge. Date: _______________________ ___________________________________ Signature ___________________________________ Print Name CERTIFICATE OF SERVICE I hereby certify that a true copy of the foregoing Consent was served (by mail) (by hand delivery) on all parties of record in this case, this _____ day of _________, 20___. ____________________________________ Signature

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