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Specific Release (Type A)
SPECIFIC RELEASE-TYPE A
For payment of [Amount Paid in Letters] dollar ([Amount Paid in Numbers]) and other forms of compensation received, [I/We], [Name of Releasor(s)], do hereby discharge and unencumber [Name of Releasee(s)], and [his/her/their] heirs and assigns, from any and all claims, demands, debts, and other liabilities that have or may come about as a result of and only pertaining to the following noted event: [Description of event]
Witness Seal