BE IT KNOWN, that ________(1)_________, (hereinafter referred to as "Releasor"), for and in consideration of the sum of _________(2)_________ ($_________) Dollars, and other valuable consideration received from or on behalf of _________(3)________, (hereinafter referred to as "Releasee"), the receipt of which is hereby acknowledged, does hereby remise, release, acquit, satisfy, and forever discharge the said Releasee, of and from all manner of

actions, causes of action, suits, debts, covenants, contracts, controversies, agreements, promises, claims and demands whatsoever, which said Releasor ever had, now has, or which any personal representative, successor, heir or assign of said Releasor, hereafter can, shall or may have, against said Releasee, by reason of any matter, cause or thing whatsoever, from the beginning of time to the date of this instrument.

IN WITNESS WHEREOF, the said Releasor has hereunto set hand and seal this _(4)_ day of ________(5)_________, 19_(6)_.

Signed, sealed and delivered in the presence of:

"RELEASOR"

_____________(7)________________ _____________(8)_______________

_____________(7)________________

STATE OF ________(9)________

COUNTY OF _______(10)_______

I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid, to take acknowledgments, personally appeared ________(11)_________, to me known to be the person described in and who executed the

foregoing instrument and acknowledged before me that it was executed for the purposes set out therein.

____________(12)______________

My Commission Expires: ________(13)________