Full, Final and Absolute Release

FULL, FINAL AND ABSOLUTE RELEASE

FOR AND IN CONSIDERATION of the sum of , cash in hand paid, the receipt

and sufficiency of which is hereby acknowledged, the undersigned does hereby release,

acquit and forever discharge their heirs, successors, agents, assigns, employees,

representatives, stockholders, and any and all other persons, firms and corporations whatsoever, from

any and all claims, demands, damages, actions, causes of action, or suits of any kind or nature

whatsoever, both known and unknown, specifically including but not limited to, any and all claims or

demands arising out, or being connected with

The parties hereby released do not admit any liability whatsoever, but expressly deny the same.

No representations as to damages or liability have been made. No promises or inducements

for this Release, not herein expressly set forth, have been made, and no such promises or inducements

are relied upon as a consideration for this Release, or otherwise, but any and all claims of

of whatever nature are hereby fully and forever released, compromised and settled.

Full and complete compromise, settlement, accord and satisfaction are hereby acknowledged,

and it is expressly agreed by the undersigned never to sue any of the parties hereby released on any

alleged promise or inducement for this Release not herein expressly set forth.

[Include this provision if appropriate!] For the same consideration aforesaid, the undersigned

do hereby release, acquit and forever discharge the from any and all claims of every kind made in

that certain action now pending in the Circuit Court of County, styled

, bearing Civil Action No. on the docket of said Court and do hereby agree

to cause said action to be dismissed with prejudice forthwith.

This Release contains the entire agreement between the parties hereto, and the terms of this

Release are contractual and not a mere recital. Since the purpose of this Release is to end this matter

forever as if the aforesaid accident never happened, should it develop that there are any errors,

mistakes or any omissions in this instrument, whether legal or factual and whether mutual or unilateral,

which would cause the release of the parties herein released to be defective or less than complete, then

the under-signed will sign any and all documents and do any and all things necessary to effectuate a

full, final and absolute release of said parties and all others having any liability in the premises.

The undersigned further state that they have carefully read the foregoing instrument; that they

know the contents thereof; that it has been fully explained to them by their attorney; that they

understands and agrees to each and every term and condition contained herein; that they signed the

same as their own free act and deed; and that they have not assigned any right arising as a result of

the above described automobile accident to any person or organization, private or governmental, so

that they retain all rights with regard to any claims, actions, expenses and/or damages arising as a

result of said accident.

WITNESS MY SIGNATURE, this the day of (Insert month),

APPROVED AND AGREED:

STATE OF

COUNTY OF

PERSONALLY APPEARED BEFORE ME, the undersigned authority in and for the

jurisdiction aforesaid, who, having been by me first duly sworn, stated on her oath that

she executed and delivered the above and foregoing Full, Final and Absolute Release on the day and

year therein indicated as her true and voluntary act and deed, and that the matters and things contained

in said Release are true and correct as therein stated.

SWORN TO AND SUBSCRIBED BEFORE ME, this the day of (Insert month),

NOTARY PUBLIC

My Commission Expires: