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Back to Forms for 'Releases and Settlements'.


RELEASE

RELEASE

CLAIMS BASED ON SPOUSE'S DEATH

 

I, ______________________________________________________ (Name), residing at ___________________________________________________________ (Address),

1for myself, my heirs, legal representatives and assigns, for the sole consideration of ________________ Dollars, receipt of which is hereby acknowledged, release and forever discharge ______________________________________________ (Releasee), of: __________________________________________________________ (Address), __________ (his or her) heirs, legal representatives, _____________________ (Agents and employees,) from any and all claims, demands and causes of action, whether past, present or future, arising out of or as a result of the fatal injury of _________________ _______________________________ (Deceased spouse), my ________________ (Husband or wife), that occurred on ___________________________ (Date), at or near _________________________________________________ (Specify location), under the following circumstances: _____________________________________________ ____________________________________________________________________________________________________________________________ (Explain).

 

Without limiting the generality of the above, this release includes all claims for personal injury, property damage, alleged wrongful death of _____________________

____________________________ (Deceased spouse), loss of services and expenses as a result of such occurrence.

 

I agree to indemnify ____________________________________________ (Releasee), _______ (His or her) heirs, legal representatives, ______________________________ (Agents and employees,) against any and all further claims, demands, rights, liabilities and suits that may hereafter be made or brought at any time by me, for myself, or in behalf of the minor children of ____________________________________ (Deceased

spouse), or by any other party arising out of or as a result of the above-described occurrence.

 

The sum specified in this release is the sole consideration for this release and such consideration is contractual and not a mere recital.  All agreements and understandings between the parties are reflected herein. I understand that _______________________ (Releasee) does not admit liability, but expressly denies the same, and that the consideration is paid in compromise of a doubtful and disputed claim or claims and to avoid the trouble and expense of further investigation and litigation.  I have executed this instrument solely in reliance on my own judgment and not in reliance on any representations or promises of _______________ (Releasee) or __________ (His or her) attorneys or representatives.  I have read and fully understand this instrument.

 

In witness whereof, I have executed this release at ____________________________ (Designate place of execution) on ____________________________________ (Date).

 

 

_____________________________________                   ____________________

Signature                                                                               Date

 

______________________________________                 ______________________

Witness                                                                                 Date

 

______________________________________                 ______________________

Witness                                                                                 Date

 

______________________________________                 ______________________

Witness                                                                                 Date



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