Fill and Sign the Louisiana Forfeiture Form

AGREEMENT STATE OF LOUISIANA PARISH OF _______ BEFORE ME, the undersigned authority, a Notary Public duly commissioned and qualified in and for the aforesaid Parish and State, PERSONALLY CAME AND APPEARED: ______________ , a person of the full age of majority and a resident of the State of _______ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ ; ______________ , a person of the full age of majority and a resident of the State of _______ , individually as contractual agent of ______________ , and herein appearing through duly authorized representative, ______________ , Attorney at Law. who, after first being duly sworn, did depose and state that: Appearer, ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , has this date received the sum of ______________ and ___ /100 ($ _______ ) DOLLARS, paid to him, in cash, in a lump sum and without discount. Appearers, ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized representative, ______________ , further declare that for and in consideration of the payment of the aforesaid amount, all of which have this date been received by them, they do hereby release, acquit and forever discharge: ______________ , individually and as Sheriff of _______ Parish, Louisiana; THE _______ PARISH SHERIFF = S DEPARTMENT (to the extent that such an entity may exist either under the laws of the State of Louisiana or the United States), together with any and all persons employed by, through or at said office; THE OFFICE OF THE DISTRICT ATTORNEY for the _______ Judicial District, in and for the State of Louisiana (to the extent that such an entity may exist either under the law of the State of Louisiana or the United States), together with any and all persons employed by, through or at said office; together with his/her/its and/or their employees, agents, representatives, officers, directors, successors, assigns, insurers, insureds, and any and all other persons, firms, corporations, partnerships, and parties whatsoever of and from any and all past, present and/or future claims, actions, demands, rights, damages, causes of action and rights of action whatsoever, known and unknown, anticipated and unanticipated, whether arising under federal or state law, to which he may be or become entitled, in any way, resulting from or to result from the incident(s) which occurred on or about _______ ___ , 20 ___ , in _______ Parish, Louisiana, which are described in, and which are the subject of, the litigation hereinafter described; and/or in any way resulting from or to result from: any and all past, present and/or future bodily and personal injuries; physical and mental pain and anguish; mental disorders; disability; disfigurement; compensation; medical expenses; other expenses; costs; loss of money (cash); all property damages, seen or unseen; loss of use, if any; loss of consortium, services, society, affection and the like; any consequences of the foregoing; and, any and all penalties, punitive damages, attorney fees and all other damages of whatsoever kind or character, which may have been sustained or might in the future be sustained by appearers in any way resulting from and/or to result from the aforesaid incident(s). Included in this release is the waiver of the rights of appearers, or their attorneys, to further assert any claim(s) whatsoever for punitive damages, attorney fees or any other element of damages whatsoever as a consequence of the hereinafter mentioned litigation and/or the incident(s) described therein. Appearers, ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized representative, ______________ , further declare that the aforesaid amount received by them, is also received in full, final and complete compromise and settlement of any and all claims asserted by them or on their behalf either in federal or state court including, but not limited to, the litigation entitled, A State of Louisiana vs. $ _______ , US Currency, _______ @ , bearing Docket Nos. _______ and _______ of the docket of the _______ Judicial District Court, Parish of _______ . Accordingly, they do hereby authorize and direct a dismissal of the aforesaid litigation with full prejudice to all of their rights. Moreover, appearers, ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized representative, ______________ , do hereby authorize and direct their attorneys to dismiss any litigation whatsoever, whether, instituted in state or federal court, as it consequents of the incident(s) described in the aforesaid litigation. ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized by representative, ______________ , fully understand and acknowledge that the claim filed by them in the litigation described in the foregoing paragraph contains allegations only, and defendants therein have denied, and continue to deny, all of said allegations. Moreover, appearers further acknowledge that all allegations urged in the aforementioned litigation are subject to dispute and are not to be construed as having been proven or substantiated in that litigation or in any other proceedings whatsoever. Therefore, considering the costs of litigation, only the consideration herein stated has been paid for this release and the covenants herein contained. Thus, it is understood and agreed that this payment is made in settlement of disputed claims and by way of compromise to avoid further litigation, and the costs attendant thereto, in the above named suit. The payment of the said sum, in view of the above, are not to be construed as an admission of liability of any nature whatsoever on the part of the parties herein released, and that in making this settlement and release, appearers are relying wholly upon their judgment, belief and knowledge of the nature, extent and duration of the injuries and damages sustained, together with the advice and counsel of their attorney of record, ______________ . Furthermore, the A released parties @ do hereby agree that, notwithstanding the allegations urged in the aforesaid litigation, in view of the dismissal of the litigation hereinabove described, they shall not pursue any claim or action against ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized representative, ______________ , and/or their attorney(s) arising from allegations urged in the said litigation. Appearers, their heirs, successors and assigns, or anyone claiming through them, further agrees to defend, hold harmless and indemnify all released parties from any and all liability or further payments to anyone or from any suit, incidental demand, or any other type of action for indemnity, contribution or payment by anyone whomsoever against the parties released herein, whether arising out of contract or in law, or however arising, on account of the incident(s) sued upon in the aforesaid litigation. ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized representative, ______________ , further agree that should any of the released parties be impleaded in any litigation where recovery is sought against any of them on any theory whatsoever, and should judgment be rendered in favor of appearers against any said party, and the judgment against any of the released parties be rendered for all or any part of the judgment in favor of appearers, then said appearers agree that they will not enforce collection of any part of such judgment which under the terms of the decree or any other judgment could ultimately be recovered from any of the released parties. It is the intention of appearers, ______________ , individually and as duly authorized representative pursuant to a Corporate Resolution, herein representing ______________ , and ______________ , herein represented by duly authorized representative, ______________ , that the released parties shall be responsible for the return of no further property or for no additional sums on account of the incident(s) claimed herein, either to appearers or anyone else, whether said sum may be reflective of personal injury damages, property damages, attorney fees, punitive damages, costs and/or for any other reason. Notwithstanding any previous provisions of this instrument to the contrary, as additional consideration for the execution of this Agreement, without which none of the parties would have agreed to same, all parties agree that all of the terms, conditions and provisions hereof shall, under no circumstances, be subject to public disclosure. Hence, the terms, conditions and provisions of this instrument shall, in no instance and for no reason, be disclosed to any person, firm, corporation, partnership or any other entity whatsoever. As used in this instrument, the term A released parties @ shall mean: ______________ , individually and as Sheriff of _______ Parish, Louisiana; THE _______ PARISH SHERIFF = S DEPARTMENT/OFFICE (to the extent that any such entity exists either under the laws of the State of Louisiana or the United States); and, to the extent that any such entity may exist under either the laws of the State of Louisiana or the United States, THE OFFICE OF DISTRICT ATTORNEY FOR THE _______ JUDICIAL DISTRICT, STATE OF LOUISIANA; and all other defendants, named and unnamed, identified or referred to, expressly or impliedly, in the litigation described herein, together with his/her/its and/or their employees, agents, representatives, officers, directors, successors, assigns, insurers, insureds and all other persons, firms, corporations, partnerships and parties whatsoever. The terms, conditions and provisions of this instrument shall be governed by, and interpreted and applied in accordance with, the laws of the State of Louisiana, notwithstanding the state, nation or territory in which the document may be executed, in whole or in part. THUS DONE AND SIGNED, in multiple originals, on the _______ day of __________________ 20 ___ , in the presence of _________________ and ___________________, the undersigned competent witnesses, who have hereunto signed their names with appearers and me, Notary, after due reading of the whole. WITNESSES: ______________________________ ______________________________ ______________ , individually and as duly authorized representative pursuant to Corporate Resolution, herein representing ______________ ______________________________ ______________________________ ______________ , Attorney for ______________ ________________________________ NOTARY PUBLIC