Fillable Form 1: UNITED STATES DISTRICT COURT NORTHERN DISTRICT (US Courts)

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Form 1: UNITED STATES DISTRICT COURT NORTHERN DISTRICT (US Courts)

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United States District Court
Northern District of California
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF CALIFORNIA
Plaintiff(s)
v.
Defendant(s).
Case No. C
CONSENT OR DECLINATION
TO MAGISTRATE JUDGE
JURISDICTION
INSTRUCTIONS: Please indicate below by checking one of the two boxes whether you (if you are the party)
or the party you represent (if you are an attorney in the case) choose(s) 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 Ninth 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:
COUNSEL FOR
(OR “PRO SE”):
Signature
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Form 1: UNITED STATES DISTRICT COURT NORTHERN DISTRICT (US Courts)

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Completed 23 February 2022

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