INDIVIDUAL’S RELEASE
State of: __________________________________ County of: ________________________________
Release executed on _________________________ (month & day) _________ (year), by __________________________________ (name), of _____________________ ________________________________ (address), here referred to as releasor, to _______________________________ (name), of _____________________________ ________________________________________ (address), here referred to as releasee.
In consideration of ___________________ Dollars ($_________), receipt of which from releasee is acknowledged, (or state other consideration), releasor voluntarily and knowingly executes this release with the express intention of effecting the extinguishment of obligations as herein designated.
Releasor, with the intention of binding ________________________ (himself/herself), ________________________________________ (name of spouse), ______________ (his/her) spouse, and __________ (his/her) heirs, legal representatives and assigns, expressly releases and discharges releasee and ___________________ (his/her) heirs and legal representatives from all claims, demands, actions, judgments and executions that releasor ever had, or now has, or may have, _________________________ (known or unknown), or that anyone claiming through or under _______________ (him/her) may have, or claim to have, against releasee or _______________ (his/her) heirs or legal representatives created by, or arising out of _______________________________ _________________________________ (description of claim with respect to which release is executed), which occurred at _________________ (place of occurrence) on ____________ (month & day), ________ (year), at ___________ (time of occurrence).
In witness whereof, releasor has executed this release at _________________________ (designate place of execution) the day and year first above written.
_____________________________________ (Signature)
_______________________ (Date)
(Acknowledgment)
(Attach statement of attorney, if desired.)