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- RELEASE
-
- FOR THE SOLE CONSIDERATION OF __________________ Dollars,
- and other consideration, the receipt and sufficiency whereof
- is hereby acknowledged, the undersigned hereby releases and
- forever discharges ___________________________, their heirs,
- executors, administrators, agents and assigns, and all other
- persons, firms or corporations liable or who might be
- claimed to be liable, none of whom admit any liability to
- the undersigned but all expressly deny any liability, from
- any and all claims, demands, damages, actions, causes of
- action or suits of any kind or nature whatsoever, and
- particularly on account of all injuries, known and unknown,
- both to person and property, which have resulted or may in
- the future develop from an accident which occurred on or
- about the day of ,19 , at or near ______________
- __________________________________________________________.
-
- The undersigned hereby declares that the terms of this
- settlement have been completely read and are fully
- understood and voluntarily accepted for the purpose of
- making a full and final compromise adjustment and settlement
- of any and all claims, disputed or otherwise, on account of the
- injuries and damages above mentioned, and for the express
- purpose of precluding forever and further additional claims
- arising out of the aforesaid accident.
-
- The undersigned hereby accepts draft or drafts as final
- payment of the consideration set forth above.
-
- IN WITNESS WHEREOF, we have hereunto set our hands and seals
- this ___ day of __________, 19__.
-
- Signed, sealed and delivered
- in the presence of:
-
- ___________________________ _______________________(SEAL)
- ___________________________ _______________________(SEAL)
-
-