Fill and Sign the Louisiana Receipt 497309148 Form

STATE OF LOUISIANA PARISH OF [_PARISH_] RECEIPT AND RELEASE BE IT KNOWN AND REMEMBERED, that before the undersigned Notary Public duly commissioned and qualified in and for the aforesaid Parish and State, and in the presence of the undersigned competent witnesses, personally came and appeared: [_CREDITOR_] (hereafter "CREDITOR"), a Louisiana corporation having its principal place of business at [_Creditor_Address_] , represented herein by [_AGENT_] , its duly authorized [_Office_] ; who, after first being duly sworn, declared that in consideration of the sum of [_$Payment_] paid this day by [_BORROWER_] (hereafter "BORROWER") to CREDITOR, receipt of which is hereby acknowledged, CREDITOR, for the purposes of making full and final compromise and settlement of the matters described herein, agrees that: The aforesaid sum is accepted by CREDITOR as full payment of any balance owed on this date on that [_Type_] obligation represented by [_Document_] . CREDITOR warrants that it has not pledged or assigned to any party any part of any obligation referred to above and agrees to defend and hold harmless BORROWER from any action by any party on any obligation referred to above. THUS DONE AND PASSED in duplicate originals in the presence of the undersigned competent witnesses, all of whom sign with me, Notary, duly commissioned and qualified in and for the said parish and state, on [_Date_] , after due reading of the whole. WITNESSES: [_CREDITOR_] _________________________ BY:____________________ [_AGENT_] [_Office_] _________________________ _______________________ [_NOTARY_] , NOTARY PUBLIC * * * * * * * * * * RECEIPT AND RELEASE : This release is given in return for payment of an unsecured conventional obligation owing to the creditor. The form allows for description of obligations based on promissory notes, open accounts, etc. WORD KEY : EXPLANATION : [_PARISH_] Parish in which release is executed. [_CREDITOR_] Name of creditor granting release. [_Creditor_Address_] Mailing address of creditor's principal place of business. [_AGENT_] Name of person appearing for creditor. [_Office_] Office held by person appearing for creditor. [_$Payment_] Amount of payment by borrower, (with $). [_BORROWER_] Name of borrower. [_Type_] Describe type of obligation (unsecured loan, open account, etc.). [_Document_] Describe any document representing the obligation (promissory note, invoices, etc.). If the obligation is one represented by a promissory note, the note should be returned marked "Paid". [_Date_] Date release is signed. [_NOTARY_] Notary before whom release is signed.