Kathryn Delelio v. Commissioner of Social Security Administration
ORDER RE: PROCEDURES IN SOCIAL SECURITY APPEAL by Magistrate Judge Alka Sagar.(See Order for complete details) (Attachments: # 1 Consent Form (Blank)) (afe)
NAME, ADDRESS & TELEPHONE NUMBER OF ATTORNEY(S) FOR, OR, PLAINTIFF OR
DEFENDANT IF PLAINTIFF OR DEFENDANT IS PRO PER
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
STATEMENT OF CONSENT TO PROCEED BEFORE A
UNITED STATES MAGISTRATE JUDGE PURSUANT
TO TITLE 28 U.S.C. § 636(c)
(For use in Report and Recommendation Cases Only)
THIS FORM SHALL BE USED ONLY IN CASES THAT HAVE BEEN ASSIGNED TO A DISTRICT JUDGE
AND REFERRED TO A MAGISTRATE JUDGE FOR A REPORT AND RECOMMENDATION.
(NOTE: PARTIES IN HABEAS CASES SHOULD USE FORM CV-11B)
NOTICE REGARDING CONSENT TO A MAGISTRATE JUDGE PURSUANT TO LOCAL RULE 73-3
Approval by the assigned District Judge is not required for cases referred to a Magistrate Judge for a
Report and Recommendation.
Parties are free to withhold consent to Magistrate Judge jurisdiction without adverse substantive
In accordance with the provisions of 28 U.S.C. § 636(c), all parties may consent to a Magistrate Judge to
conduct all further proceedings, including jury or non-jury trial (if applicable), and entry of final
Judgment, by executing and filing a joint (or separate) statement(s) of consent, setting forth such election.
If all parties consent to the jurisdiction of a Magistrate Judge, any appeal would be made directly to the
United States Court of Appeals.
CONSENT TO A MAGISTRATE JUDGE
I voluntarily consent to have a United States Magistrate Judge conduct all further proceedings in this case,
including a trial (if applicable), and order the entry of final Judgment.
Name of Counsel OR Party if Pro Se
Signature and date
Counsel for (Name Parties)
STATEMENT OF CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGE PURSUANT TO TITLE 28 U.S.C. § 636(c)
(For Use in Report and Recommendation Cases Only)
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