Consent To Jurisdiction By Magistrate Judge

IN THE UNITED STATES DISTRlCT COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA Plainti fqs) VS. 1 1 1 ) ) Case No. 1 PART 1: CONSENT TO JURISDICTION BY UNITED STATES MAGISTRATE JUDGE In accordance with the provisions of Section 636(c)(1) of Title 28, United States Code, I voIuntarily consent 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 United States Court of Appeals for the Third Circuit if an appeal is filed. Date: Signature Print Name: PART 2: DISTRICT JUDGE OPTION Pursuant to Section 636(c)(2) ofTitle 28, United States Code, I acknowledge the availability of aUnited States Magistrate Judge but I elect to have this case randomly assigned to a United States District Judge. Date: Signature Print Name: American LegalNet, Inc. www.FormsWorkFlow.com