Fill and Sign the Wrongful Death 497330312 Form

Settlement Agreement and Release in Wrongful Death Suit Prior to Filing of Suit Agreement made on the ____________________________________ (date) , between ____________________________________ (Name of Claimant) , of __________________ ___________________________________________________________________________ (street address, city, county, state, zip code) , hereinafter called Claimant , and ___________________________________ (Name of Opponent) of ___________________ ___________________________________________________________________________ (street address, city, county, state, zip code) , hereinafter called Opponent . Whereas, Claimant , having qualified and been appointed Administrator (or Executor) of the Estate of ____________________________________ (Name of Decedent) , deceased, believes that Claimant may have a lawful and enforceable claim against Opponent for the wrongful death of the Decedent , which claim is based on the following facts and considerations: (describe circumstances leading to death of Decedent) ________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ . Whereas, Claimant intends to initiate a wrongful death action against Opponent and others under the provisions of (cite applicable state statute) __________________________ __________________________________________ for damages of $_______________. Whereas, Opponent denies all responsibility for the death of Decedent and asserts that Opponent is not liable to Claimant in any amount whatever; however, to preclude the expense and inconvenience of legal proceedings, Opponent is willing to settle the claim according to the terms and conditions set forth below. Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Payment to Claimant Opponent shall pay to Claimant the sum $_______________in full settlement of all claims that Claimant now has or may subsequently have against Opponent for the death of Decedent or for any act or omission concerning the incident that resulted in the death. 2. Release of Claim As consideration for such payment by Opponent , Claimant shall not institute any legal proceedings against Opponent in any court for any reason connected with the death of Decedent , and Claimant forever discharges Opponent from all claims, demands, damages, actions, and causes of action whatever as have arisen or may arise in connection with the death or the circumstances surrounding the death of Decedent . 3. Approval by Probate or Surrogate Court This Agreement shall be conditioned on its being consented to and approved by the Probate Court (or Surrogate Court) of _____________________________ (County & State) . Witness our signatures as of the day and year first above written. Estate of __________________________________ (Name of Decedent) By: _______________________________ ______________________________ __________________________________ _______________________________ (Name & Signature of Executor (Name and Signature of Opponent) or Administrator)