Fill and Sign the Settlement Agreement and General Release Secgov Form

STATE OF ALABAMACOUNTY OF _______________ SHAREHOLDER’S INDEMNITY AGREEMENT WHEREAS_____________________________ is presently the owner of ______ shares of stock in _________________________________________, which shares of stock are represented by Certificate No. _____ (issued to _______________________________ for _____ shares); andWHEREAS a certificate purporting to represent ______ shares of stock in ____________________________________________, being Certificate No. ____, to ____________________________________________; andWHEREAS the undersigned further represent that Certificate No. ____ identified above has been lost, stolen, or destroyed, and cannot be found or produced; and WHEREAS in reliance upon the foregoing representations, warranties, and promises, _______________________________________, is about to issue a new stock certificate to _______________________________ for the _____ shares of stock represented by Certificate No. ____; NOW, THEREFORE the undersigned, _____________________________________ agrees to indemnify and hold harmless ______________________________________, its officers, directors, shareholders, successors, and assigns and __________________________________ against all claims, actions, and suits, whether groundless or otherwise, and from any and all liabilities, losses, damages, costs, charges, attorney fees, court costs, and other expenses of every nature and character, arising out of, caused by, or in any manner growing out of Certificate No. ____, or the failure of Certificate No. ____ to be produced, or the later subsequent discovery of said certificate or any claim against the earnings or assets of ___________________________________, by virtue of Certificate No. ____. The undersigned further promise and agree that if Certificate No. ____ is found or recovered that they will deliver or cause to be delivered such certificate to _________________, for cancellation. Dated this _______ day of ____________________ ________. STATE OF ALABAMACOUNTY OF _______________ I, the undersigned authority, a Notary Public in and for said County, in said State, do hereby certify that_______________________________, whose name is signed to the foregoing document and who is known to me, acknowledged before me on this day, that, being informed of the contents of the document, he/she executed the same voluntarily on the day the same bears date.Given under my hand and official seal, this day of__________________ _______. .......................................................................Notary Public