Please use the fact pattern I provided you to complete the attached Release of All Claims. Complete the three blank spaces as well as the date and signature lines.

Release of All Claims

The undersigned being of lawful age, for the sole consideration of ________________ to the undersigned in hand paid, receipt where of is hereby acknowledged, does hereby and for out heirs, executors, administrators, successors and assigns release, acquit and forever discharge____________ and their agents, servants, successors, heirs, executors, administrators and all other persons, firms, corporations, associates or partnerships of and from any and all claims, actions, causes of action, demands, rights, damages, costs, loss of service, expenses and compensation what so ever , which the undersigned now has / have or which may hereafter accrue on account of or in any way growing out of any and all known and unknown, foreseen and unforeseen bodily and personal injuries and property damage and the consequences thereof resulting or to result from any and all actions arising from __________________________________________________________________________________

It is understood and agreed that this settlement is the compromise of a doubtful and disputed claim, and that the payment made is not to be constructed as an admission of liability on the part of the party or parties hereby released, and that said releases deny liability therefore and intend merely to avoid litigation and buy their peace.

It is further understood and agreed that all rights under Section 1542 of the Civil Code of California and any similar law of any state or territory of the United States are hereby expressly waived. Said section reads as follows:

1542. Certain Claims not affected by general release. A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.

The Undersigned further declares and represents that the damages sustained are or may be permanent and progressive and that recovery there from is uncertain and indefinite and in making this Release it is understood and agreed, that the undersigned relies wholly upon the undersigneds judgment, belief and knowledge of the nature, extent, affect and duration of said damages and liability therefore and is made without reliance upon any statement or representation of the party or parties hereby released or their representatives.

The undersigned further declares and represents that no promise, inducement, or agreement not herein expressed has been made to the undersigned, and that this Release contains the entire agreement between the parties here to, and that the terms of this Release are contractual and not mere recital.

FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM:

IT IS UNLAWFUL TO:

1. PRESENT OR CAUSE TO BE PRESENTED ANY FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS UNDER A CONTRACT OF INSURANCE
2. PREPARE, MAKE, OR SUBSCRIBE ANY WRITING WITH INTENT TO PRESENT OR USE THE SAME, OR TO ALLOW TO BE PRESENTED OR USED IN SUPPORT OF ANY SUCH CLAIM. EVERY PERSON WHO VIOLATES ANY PROVISION OF THIS SECTION IS PUNISHABLE BY IMPRISONMENT IN THE STATE PRISON NOT EXCEEDING THREE YEARS, OF BY FINE NOT EXCEEDING ONE THOUSAND DOLLARS OR BY BOTH.

THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTAND IT.

Signed, sealed and delivered this_____________ day of ____________.

CAUTION: READ BEFORE SIGNING BELOW

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Print Name Signature

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Print Name Signature

Witness