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RELEASE OF ALL CLAIMS
State of _______________________________________
County of _____________________________________
The undersigned, ________________________________________________ (name), of _____________________________________________________(address), here referred to as Releasor, for and in consideration of _______________________, the receipt of which is hereby acknowledged, and in further consideration of the execution by ______________________________, Releasee, of a dismissal with prejudice of Releasees counterclaim against the undersigned in the case of _____________________________ v. ______________________________, Civil Case No. ______________, in the _________________ court, Releasor, being of lawful age, does hereby release, acquit and forever discharge Releasee and all other persons and entities 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 resulting or to result from the accident that occurred on or about ________________ (date), at or near _____________________________________________________(location).
Releasor declares and represents that the injuries sustained are permanent and progressive and that recovery therefrom is uncertain and indefinite. Releasor further declares and represents that in making this release and agreement, it is understood and agreed that:
(1) Releasor relies wholly upon Releasorï¿½s own judgment, belief and knowledge of the nature, extent and duration of such injuries; and(2) Releasor has not been influenced to any extent whatever in making this release by any representations or statements regarding such injuries, or regarding any other matters, made by the person(s), firm(s) or corporation(s) who are hereby released, or by anyone representing such person(s), firm(s) or corporation(s), or by any physician or surgeon employed or compensated by such person(s), firm(s) or corporation(s).
It is further understood and agreed that this settlement is the compromise of a doubtful and disputed claim, and that the payment made hereunder is not to be construed as an admission of liability on the part of Releasee, by whom liability is expressly denied.
It is the intention of the undersigned in signing this release to bind himself, _____________________________ (name of spouse), _____________his spouse, and his heirs, executors, administrators and assigns. This release is for the benefit of Releasee and Releasees agents, successors, heirs, executors, administrators, assigns, and all others who may be liable to Releasor for damage to person or property arising out of the above-described accident.
This release contains the entire agreement between and among the parties hereto, and the terms of this release are contractual and not a mere recital.
I, the undersigned, have carefully read the foregoing release and know and understand the contents thereof. I sign this release voluntarily as my own free act with full knowledge of its significance, intending to be legally bound thereby.
Signed at ______________________________________________ (Designate place of execution).
Executed in the presence of:
These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.
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