Release executed on __________ (date), by __________________________________ (name) of _____________________________________________________ (address), here referred to as releasor, in favor of ____________________________________, of _________________________________________________________ (address), here referred to as releasee.


In consideration of ______________ (the sum of __________ Dollars ($__________ ), receipt of which from releasee is acknowledged or recite other consideration), releasor, for __________ (himself or herself) and ___________ ( __________ (his or her) heirs, executors and administrators), has remised, released and forever discharged, and by these presents does, for __________ (himself or herself) and ___________ (his or her) heirs, executors and administrators), remise, release, acquit, satisfy and forever discharge ___________________________________ (releasee), __________ (__________ (his or her) successors, heirs, executors and administrators), of and from all, and all manner of action and actions, cause and causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, executions, claims and demands whatsoever, in law, or in equity, which against releasee, releasor ever had, now have, or which releasor's successors, heirs, executors or administrators, hereafter can, shall, or may have, for, upon or by reason of any matter, cause, or thing whatsoever.


In witness whereof, releasor executes this release at ____________________________ (designate place of execution) on the day and year first above written.




_____________________________________                      ______________________

Signature                                                                                                           Date


 (Attach statement of attorney, if desired)