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Back to Forms for 'Releases and Settlements'.





Release executed on __________ (date), by __________________________________ (name), of _____________________________________________________ (address), here referred to as Releasor, to ______________________________________ (name),

(if applicable, a corporation organized under the laws of the State of _____________ ), of (or if Releasee is a corporation with its principal place of business located at) ______________________________________________________________ (address), here referred to as Releasee.




A.  Releasor is the owner __________________ (in fee simple or as the case may be) of certain property located at ______________________________________________

(address), and more particularly described as follows: _________________________ _____________________________________________________________________


(Set forth legal description).


B.  Releasor’s above-described property and the improvements thereon have suffered damage as a result of _____________________________________________________ (business activities of Releasee conducted on adjacent property, described as follows or

the following described incident for which Releasee is allegedly responsible or otherwise liable as the case may be): _______________________________________ _____________________________________________________________________


(description of activities, incident or the like).


C.  Releasor is willing to release Releasee from all past and present claims for such damage on the terms set forth herein.


In consideration of _______________ (the sum of __________ Dollars receipt of which is acknowledged by Releasor or set forth other consideration), Releasor releases and discharges Releasee from any and all claims, demands and causes of action

that Releasor ever had or that Releasor has or may have on the date of this release, known or unknown, arising from the above-described __________________________ (business activities conducted by Releasee).  It is understood that this release shall inure

to the benefit of Releasee and _________________ (its successors, assigns and insurers), and that it shall bind Releasor and Releasor’s heirs, legal representatives, assigns and successors in interest to the above-described real property.


 (If appropriate, here add:  Releasor agrees to indemnify Releasee against ____________ (loss and expense) with respect to any claims, demands and causes of action of any tenants or occupants of the above-described property, which claims, demands or causes of action are based on damage to the property or occupancy thereof by virtue of the above-mentioned ______________________________ (business activities of Releasee).)


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



_____________________________________                      ____________________

Signature                                                                                                           Date



_____________________________                                        _____________________

Witness                                                                                                             Date


______________________________                                      _____________________

Witness                                                                                                             Date


_____________________________                                        _____________________

Witness                                                                                                             Date




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