RELEASE OF CLAIMS

In consideration of the sum of [amount]           Dollars,
($      ), the receipt of which is hereby acknowledged,
[name of creditor] of   [address]   , City of             ,
County of             , State of              , does hereby
release and discharge the estate, administrator, executor
and heirs of the decedent from any and claims that [name of
creditor] has or may have in the future against the estate
of [name of deceased], deceased.

Dated: _____________                  _____________________
                                           [Signature]
[Acknowledgement]