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Damage Claim Assignment
FOR GOOD AND VALUABLE CONSIDERATION, receipt of which consideration is hereby acknowledged, I/we do hereby convey, pass, and assign to [Name] of [Address] hereinafter referred to as "Assignee", as evidenced by my[our] signature below, all and any of my[our] ownership rights, interests, and claims of any type in the matter, more specifically described as: [enumerate].
The assignor represents the rights and interests of the above matter as being fully and completely assignable. Further, the assignor guarantees that the above matter has not been settled. The assignor additionally agrees to provide all reasonable assistance to the Assignee in pursuing the above-described claim.
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]