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TO ALL WHOM THESE PRESENTS SHALL COME OR MAY CONCERN
GREETING: KNOW YE, that I, [Name], residing at [Address], for and in consideration of the sum of [$------], lawful money of the United States to me in hand paid by [name], residing at [address], the receipt of which is acknowledged, have remised, released, and forever discharged and by these presents do for myself, my heirs, executors, administrators, and assigns, remise, release, and forever discharge the said [name], and [name]'s heirs, executors, administrators, successors, and assigns of and from all and any manner of action and actions, cause and causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, executions, claims, and demands whatsoever, in law, in admiralty, or in equity, that against the said [name] I ever had, now have, or that my heirs, assigns, executors, or administrators, hereafter can, shall, or may have for, upon, or by reason of any matter, cause, or thing whatsoever from the beginning of the world to the date of these presents and more specifically a cause of action arising out of [nature of cause of action].
This release may not be changed orally.
Signature & Name
This Section for Notary:
State of _________
County of ________ [COUNTY]
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.
My commission expires: _____