Party Represented Signature Date ABC Trucking Company / /
Country
United States / /
Facility
M arch / /
Organization
Represented Signature Date / Clerkâs Office / Court of Appeals / UN Court / Removing Party / IN PRO / /
Person
John Smith / George S. Britt / Q. Harrison Plaintiff / Mary Alice Jones / Phyllis Q. Harrison / /
Position
Magistrate / MAGISTRATE JUDGE / V. ADDITIONAL PARTIES Counsel / attorney / agistrate Judge / Clerk / deputy clerk / counsel / Governor / General / District Judge / U.S. District Judge / the above named Magistrate Judge / U.S. District Judge for further proceedings / US Magistrate Judge / U.S. District Judge / /
UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS PROCEDURES AND OTHER INFORMATION FOR COMPLETING THE FORM FOR CONSENT OR REFUSAL OF MAGISTRATE JUDGE JURISDICTION (updated[removed])