Specific Release

FOR GOOD AND VALUABLE CONSIDERATION, the receipt and sufficiency of which being hereby acknowledged, the undersigned hereby releases, discharges and acquits__________________________________, together with his heirs, executors, administrators, successors and assigns from any claim or liability arising from:




Provided that this release applies only to the foregoing, and no other debt, obligation, agreement or liability by and between the parties, which, if existing, shall survive this release.


Dated this______ day of___________________, 201(x).


IN WITNESS WHEREOF I have hereunto set my hand and seal on the day and year first above written.

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