Release executed on __________ (date), by __________________________________

and __________________________________________ (names), husband and wife, of ___________________________________________________________ (address),

here referred to as Releasors, to ___________________________________________ (name), of ____________________________________________________________ (address), here referred to as Releasee.

In consideration of the sum of __________________ Dollars from Releasee, receipt of which is jointly and severally acknowledged, Releasors voluntarily and knowingly execute this release with the intent of effecting the extinguishment of obligations as herein designated.

Releasors, with the intention of binding themselves and their respective heirs, legal representatives and assigns, expressly release and discharge Releasee (if applicable, insert here: and _______________ (his or her) heirs and legal representatives) from all claims, demands and causes of action that Releasors ever had, now have, or may have, _________________ (known or unknown), or that anyone claiming through or under

either of them may have, or claim to have, against Releasee (if applicable, insert here: ______________ (his or 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 ________________ (date of occurrence) at ______________ (approximately) _____________ (time of occurrence).

In witness whereof, Releasors have executed this release at ______________________ (designate place of execution) the day and year first above written.

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Signature Date

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Signature Date

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Witness Date

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Witness Date

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Witness Date