Release of Assignment of Wages
This Release is made by (Name of Assignee), a corporation organized and
existing under the laws of the state of (name of state), with its principal office located at
(street address, city, state, zip code), referred to herein as Assignee, in favor of (Name
of Assignor) of (street address, city, state, zip code), referred to as Assignor.
1. On (date), Assignor executed a written assignment to Assignee of the wages of
Assignor in the amount of $___________ earned in the employ of (Name of Employer),
securing an indebtedness recited in the Assignment instrument.
2. On (date), the assignment and the indebtedness were fully paid and satisfied.
3. The Assignment is by this instrument released and discharged.
(Name of Assignee)