Allen v. Commissioner of Social Security et al

Filing 4

ORDER GRANTING Plaintiff's 3 Motion to Proceed IFP; ORDER DIRECTING the Clerk of the Court to serve Plaintiff with Magistrate Judge consent form; ORDER DIRECTING Plaintiff to complete and file the Magistrate Judge consent form no later than June 16, 2017, signed by Magistrate Judge Gary S. Austin on 05/23/17. (Attachments: # 1 consent/decline form) (Deadline: 06/16/2017)(Martin-Gill, S)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF CALIFORNIA AT FRESNO

CASE NO. ______________________

______________________________
Plaintiff(s)/Petitioner(s),

vs.

________________________________
Defendant(s)/Respondent(s)

IMPORTANT:
/ CHECK AND SIGN ONLY ONE SECTION OF THIS FORM,
THEN RETURN IT TO THE CLERK’S OFFICE NOT LATER THAN 20 DAYS
FOLLOWING YOUR FIRST APPEARANCE, ANSWER OR RESPONSIVE
PLEADING.

9

CONSENT TO JURISDICTION OF
UNITED STATES MAGISTRATE JUDGE
In accordance with the provisions of Title 28, U.S.C. Sec. 636(c)(1), the undersigned
hereby voluntarily consents to have a United States Magistrate Judge conduct all further
proceedings in this case, including trial and entry of final judgment, with direct review by the
Ninth Circuit Court of Appeals, in the event an appeal is filed.
Date: ___________________

Signature: _______________________________
Print Name:______________________________
( ) Plaintiff/Petitioner

( ) Defendant/Respondent

( ) Counsel for * _________________________

9

DECLINE OF JURISDICTION OF
UNITED STATES MAGISTRATE JUDGE

Pursuant to Title 28, U.S.C. Sec. 636(c)(2), the undersigned 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:______________________________
( ) Plaintiff/Petitioner

( ) Defendant/Respondent

( ) Counsel for *_________________________

*If representing more than one party, counsel must indicate name of each party responding.
g:\docs\docket\prisoner/cnsent-d.w pd ( 9/17/03)