KNOW ALL MEN BY THESE PRESENTS:
That we, ______________________________________________ and
___________________________________
(Husband)
(Wife)
husband and wife, residing at
_____________________________________________________________________
and each being of lawful age, for the sole consideration of _______________________________________________
_______________________________________________________________________dollars ($_____________)
to be paid to _____________________________________________ have
remised, released, and forever discharged
and by these presents do,
severally and jointly, for ourselves and for our heirs, executors,
administrators, and
assigns, do by remise, release, and forever discharge ___________________________________________________
____________________________________________________________________________________________
and his, her, their, and its successors arid assigns, and each of their
heirs, executors, and administrators, and all other Persons, firms, and
corporations, of and from any and all Claims, demands, rights, and causes
of action, of whatsoever kind or nature, arising from or by reason of any and
all known and unknown., foreseen and unforeseen bodily and personal
injuries, loss arid damage to property, and the consequences thereof, resulting, and to result, from a _________________
which happened on or about the ____________________________ day of _________________, 20________ at or near
_____________________________________________________________________________________________
It is further understood and agreed that this settlement is the compromise
of doubtful and disputed claims, and that the payments are not to be construed
as an admission of liability on the part of ____________________________________
__________________________________________ by whom liability is expressly,
denied.
This release contains the ENTIRE AGREEMENT between the parties
hereto, and the terms of this release are contractual and riot a more recital.
We further state that we have carefully read the foregoing release and know
the contents thereof, and we sign the same as our own free acts.
WITNESS our hands and seals this ____________________day
of____________________________ , 20 _________.
SIGNED IN THE PRESENCE
OF
CAUTION: READ BEFORE SIGNING
_______________________________________________
_______________________________________________ _______________________________________(SEAL)
_______________________________________________ _______________________________________(SEAL)
_______________________________________________
State of ______________________________________
County of ____________________________________
On the
_________________________ day of __________________________20_______ before me
personally appeared
______________________________________________a n
d ____________________________________________ to me known to be the persons who
signed the foregoing release, and after I had fully explained to them the nature
and legal effect thereof acknowledged that they fully understand its contents
and meaning and duly executed the some as their free act and deed and for the
sole consideration tlierein expressed.
IN TESTIMONY WHEREOF, I have
hereunto set my hand and affixed my notarial seal on the day and year first
above
written.
__________________________________________________
Notary Public
My commission expires ___________________________________________
(If this release is acknowledged before a Notary Public, no witnesses' signatures are necessary.)
FORM NO. GEN HUSB/WIFE
OHIO ADJUSTER'S
DIRECTORY
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