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(TYPE 2)



For and in consideration of the payment to me of $ ________________, the receipt of

which is hereby acknowledged, I, ___________________________________________ (Name), the undersigned, of ________________________________________________ (address), court appointed legal guardian of __________________________________ (Name of ward), ___________________ (Minor,) do forever release, acquit, discharge

and covenant to hold harmless _____________________________________________ (Names of parties to be released), their heirs, successors and assigns of and from any and

 all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation, on account of, or in any way growing out of, any and all known and unknown personal injuries and property damage which I may now or hereafter have as

the legal guardian of ________________________ (Name of ward) and also all claims

or rights of action for damages which _______________________________________ (Name of ward) has or may hereafter have resulting or to result from a certain ________ __________ (Automobile) accident that occurred on or about _____________ (Date), at:

____________________________________________________________ (Location of accident), which accident was subsequently made the cause of action in the case of ___________________________ v. __________________________, Civil Case No. ____________, filed on __________ (Date), in __________________ (Specify court).


I further promise to bind myself my heirs, administrators and executors jointly and severally, to repay to ______________________________________________ (Names

of parties to be released), their heirs, successors and assigns any sum of money, except

of the sum mentioned above that I may hereafter be compelled to pay on behalf of ____________________________________________ (Ward) because of such accident.


It is further understood and agreed that the settlement is the compromise of a doubtful

and disputed claim and that this payment is not to be construed as an admission of

liability on the part of ______________________________________ (Parties to be released) by whom liability is expressly denied.


I further state that I have carefully read the foregoing Release and know the contents thereof, and that I sign this Release as my own free act.



_____________________________________                     _____________________

Signature                                                                                                           Date



Approved as to Form and Content:



_____________________________________                     _____________________

Signature                                                                                                           Date


Judge of __________________________________________________ (specify court)


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