FOR VALUE RECEIVED,
the undersigned hereby sells and transfers to
__________________________, (the "Assignee") and its successors, assigns and
personal representatives, any and all claims, demands, and cause or causes of
action of any kind whatsoever which the undersigned has or may have against
_______________________________, arising from the following matter:
___________________________________________
___________________________________________
___________________________________________
And the undersigned agrees that__________________________ may in its own name and for its own benefit prosecute, collect, settle, compromise and grant releases on the said claim as it in its sole discretion deems advisable.
Dated this______ day of__________________, 200(X) .
IN WITNESS WHEREOF I have hereunto set my hand and seal on the day and year first above written.
_______________________ _________________________
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