Fillable Printable General Release Form - Individual
Fillable Printable General Release Form - Individual
General Release Form - Individual
GENERAL RELEASE-INDIVIDUAL
TO ALL INTERESTED PARTIES KNOW THAT
, Releasor
In consideration of the sum of ($ )
Received from , Releasee, the adequacy and receipt
whereof is hereby acknowledged by Releasee, releases and discharges the Releasee, the
Releasee’s executors, administrators, heirs, successors and assigns (hereinafter collectively
sometimes referred to as “Releasees”) from all causes of actions, actions, debts, sums of
money, accounts, bonds, bills, covenants, contracts, controversies, promises, agreements,
trespasses, variances, judgments, damages, executions, claims, demands whatsoever, in law,
equity and/or admiralty, which against the said Releasees, the Releasor, his/her executors,
administrators, successors and assigns have, ever had or may have in the future, by reason of
any matter, cause or thing whatsoever from the beginning of time to the date hereof.
The words “Releasor” and “Releasee” include the singular and the plural wherever
construction of this instrument dictates.
This Release may only be changed in writing.
IN WITNESS WHEREOF, the Releasor has executed this Release on the day of
WITNESS:
________________________________
By: _____________________________
ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE
State of New York, County of , ss:
On the day of in the year ,
before me, the undersigned, personally appeared
,
personally known to me or proved to me on the basis of satisfactory
evidence to be the individual(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 capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or the
person upon behalf of which the individual(s) acted, executed the
instrument.
ACKNOWLEDGEMENT BY SUBSCRIBING WITNESS
TAKEN IN NEW YORK STATE
State of New York, County of , ss:
On the day of in the year ,
before me, the undersigned, a Notary Public in and for said State,
personally appeared
,
the subscribing witness to the foregoing instrument, with whom I am
personally acquainted, who, being by me duly sworn, did depose and
say that he/she/they reside(s) in
(if the place of residence is in a city, include the street and street number if any, thereof);
that he/she/they know(s)
to be the individual described in and who executed the foregoing
instrument; that said subscribing witness was present and saw said
execute the same; and that said witness at the same time subscribed
his/her/their name(s) as a witness thereto
ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE
State of New York, County of , ss:
On the day of in the year ,
before me, the undersigned, personally appeared
,
personally known to me or proved to me on the basis of satisfactory
evidence to be the individual(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 capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or the
person upon behalf of which the individual(s) acted, executed the
instrument.
ACKNOWLEDGEMENT TAKEN OUTSIDE NEW YORK
STATE
*State of , County of , ss:
*(Or insert District of Columbia, Territory, Possession or Foreign County)
On the day of in the year ,
before me, the undersigned, personally appeared
,
personally known to me or proved to me on the basis of satisfactory
evidence to be the individual(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 capacity(ies), that by his/her/their
signature(s) on the instrument, the individual(s) or the person upon
behalf of which the individual(s) acted, executed the instrument, and
that such individual make such appearance before the undersigned in
the
(add the city or political subdivision and the state or country or other
place the acknowledgement was taken).
TitleNo.
TO
SECTION:
BLOCK:
LOT:
COUNTY OR TOWN
:
RETURN BY MAIL TO:
DISTRIBUTED BY
The Judicial Title Insurance Agency LLC
800-281-TITLE (8485) FAX: 800-FAX-9396
2004
GENERAL RELEASE
Individual
________________________________
_________________________________
Dated:
Prepared By The Law Offices Of:
