General Release
Releasor:	____________________
Address:	____________________
____________________
Releasee:	____________________
Address:	____________________
____________________
1. Releasor voluntarily and knowingly signs this release with the express intention of eliminating Releasee's legal liabilities and obligations as described below.
2. Releasor hereby releases Releasee from all claims, known or unknown, that have arisen or may arise from the following occurrence: _____________________________. Releasor understands that, as to claims that are known to the parties when the release is signed, any statutory provisions that would otherwise apply to limit this general release are hereby waived. Releasor also understands that this release extends to claims arising out of this incident that are not known by Releasor at the time this release is signed.
3. In exchange for granting this release, Releasor has received the following payment or other considerations :______________________________.
4. By signing this release, Releasor additionally intends to bind his or her spouse, heirs, legal representatives, assigns, and anyone else claiming under him or her. Releasor has not assigned any claim covered by this release to any other party. Releasor intends that this release apply to the heirs, personal representatives, assigns, insurers, and successors of Releasee as well as to the Releasee. 

_____________________________________________	__________________
Releasor's signature	Date

_____________________________________________	__________________
Print name	County of residence

_____________________________________________	__________________
Releasor's spouse's signature	Date

_____________________________________________	__________________
Print name	County of residence

_____________________________________________	__________________
Releasee's signature	Date

_____________________________________________	__________________
Print name	County of residence

_____________________________________________	__________________
Releasee's spouse's signature	Date

_____________________________________________	__________________
Print name	County of residence

Certificate of Acknowledgment of Notary Public

State of _______________________________	)
	)	ss
County of _____________________________	)

On _____________________, before me, ______________________________, a notary public in and for said state personally appeared ___________________ ________________________, known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that he or she executed the same in his or her authorized capacity and that by his or her signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument.
	WITNESS my hand and official seal.
	_____________________________________
	Notary Public for the State of ______________
	My commission expires __________________
[NOTARY SEAL]