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Individuals Release--Dismissal Of Pending Action
INDIVIDUALS RELEASE-DISMISSAL OF PENDING ACTION
I, [Name of Releasor], of [Address of Releasor], the undersigned, with the intent of binding myself, [Name of spouse], my spouse, and my heirs, legal representatives and assigns, execute this release in favor of [Name of Releasee], of [Address of Releasee], here referred to as releasee.
In consideration of the sum of $ [Amount Paid] Dollars, receipt of which from releasee is acknowledged, I release and discharge releasee and [his or her] heirs, legal representatives and assigns, from all claims, present and future, known or unknown, in any manner arising out of property damage and personal injuries sustained by me as a result of
[Description of incident forming basis of claim].
I authorize releasee to pay the consideration for this release directly to my attorney, [Name of Attorney], Attorney at Law, whose office is located at [Address of Attorney].
I authorize and direct my attorney, [Name of Attorney], to execute (in duplicate) a motion for dismissal with prejudice of the complaint or petition or declaration in the action now pending in the [Name of the court], entitled [Name of Plaintiff] v [Name of Defendant], Civil Case No. [Number of Civil Case], involving the claim described above in this release. A copy of such motion will be delivered to [Name of the other Attorney], Attorney at Law, whose office is located at [Address of the other Attorney], attorney for releasee, contemporaneously with the payment of Dollars $ [Amount paid] as previously set out by the terms of this release.
I have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance.
In witness whereof, I have executed this release at [Place of execution] on [Date of execution].
Signature Date
(Acknowledgment)
(Attach statement of attorney, if desired.)