Dollars, $ ______________________ 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
deemed 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_________________, 20_______________
at or near________________________________________________________________________________________
__________________________________________________________________________________________________
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 any further or additional claims arising out of the
aforesaid accident.
The undersigned is stating with this instrument, they are in fact the sole owner of said property located at :
__________________________________________________________________________________________________
__________________________________________________________________________________________________
and agrees to provide evidence to document proof of ownership to the above mentioned property/s.
Undersigned hereby accepts draft or
drafts as final payment of the consideration set forth above.
In Witness Whereof,
________________________________have hereunto set____________________hand and
seal this
_________________________ day
of________________________________________, 20 _____________.
In presence
of
(Seal)
(Seal)
(Seal)
annuit Coeptis 591