UNITED STATES DISTRICT COURT
for the
NORTHERN DISTRICT OF ALABAMA
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Plaintiff, }
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v. } Case No.:
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Defendant. }
CONSENT OR DECLINATION TO MAGISTRATE JUDGE JURISDICTION
INSTRUCTIONS: Please indicate below by checking one of the two boxes whether you
choose to consent or decline magistrate judge jurisdiction in this matter. Sign this form below
your selection.
Consent to Magistrate Judge Jurisdiction
In accordance with the provisions of 28 U.S.C. § 636(c), I voluntarily consent to have a United
States magistrate judge conduct all further proceedings in this case, including trial and entry of
final judgment. I understand that appeal from the judgment shall be taken directly to the United
States Court of Appeals for the Eleventh Circuit.
OR
Decline Magistrate Judge Jurisdiction
In accordance with the provisions of 28 U.S.C. § 636(c), I decline to have a United States
magistrate judge conduct all further proceedings in this case and I hereby request that this case
be reassigned to a United States district judge.
DATE: NAME:
Signature
