CV-11D (1/19)
STATEMENT OF CONSENT TO PROCEED BEFORE A UNITED STATES MAGISTRATE JUDGE
Page 1 of 2
(For use in Reassignment of Civil Cases to United States Magistrate Judges on Voluntary Consent List only)
NAME & CONTACT INFORMATION REQUIRED BY L.R. 11-3.8 OF ATTORNEY(S) OR PRO PER:
ATTORNEY(S) FOR:
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
Plaintiff(s)
v.
Defendant(s)
CASE NUMBER:
____ CV __________________
STATEMENT OF CONSENT TO PROCEED BEFORE A
UNITED STATES MAGISTRATE JUDGE
(For use in Reassignment of Civil Cases to United States
Magistrate Judges on Voluntary Consent List only)
(THIS FORM SHALL BE USED ONLY FOR CASES IN WHICH ALL PARTIES CONSENT TO A VOLUNTARY
CONSENT LIST MAGISTRATE JUDGE PURSUANT TO GENERAL ORDER NO. 18-11)
The parties signing below acknowledge the following: As provided in General Order No. 18-11, the parties may select
any Magistrate Judge from the Voluntary Consent List maintained by the Clerk of Court to conduct all further
proceedings in this case, pursuant to 28 U.S.C. § 636(c) and F.R.Civ.P. 73(b), if ALL PARTIES consent to the
jurisdiction of that Magistrate Judge. Consent to proceed before a Magistrate Judge may be withheld by any party
without any adverse consequences. If a case is reassigned to a Magistrate Judge pursuant to General Order No. 18-11,
any appeal from a judgment of that Magistrate Judge shall be taken to the United States Court of Appeals in the same
manner as an appeal from any other judgment of the District Court, in accordance with 28 U.S.C. § 636(c)(3).
The undersigned party or parties hereby voluntarily consent to have the following United States Magistrate Judge,
chosen from the Voluntary Consent List maintained by the Clerk of Court, conduct all further proceedings in this case,
including trial and final judgment:
[insert name of selected United States Magistrate Judge]
Name of Counsel
(OR
Party if Pro Per)
Signature and date Counsel for (Name of Party or Parties)
G
Party lodging this form shall check this box to confirm that ALL PARTIES have consented to proceed before the
selected Magistrate Judge.
Please note: Unless the case or filing party is exempt from electronic filing, this completed form must be
electronically filed as an attachment to a Notice of Lodging, as required by Local Rule 5-4.4; after the
written consent of all parties has been submitted to the Court, this completed form must be e-mailed to
the assigned District Judge’s generic chambers e-mail address using the CM/ECF System. If the case or
filing party is exempt from electronic filing, the written consent of all parties may be lodged with the
Clerk in paper form pursuant to Local Rule 5-1.
