SPECIFIC RELEASE
  

For consideration, I, * , whose address is * , releases * , whose address is * , from the following
specific claims and obligations: *


arising from the following transaction or incident: *


Any claims or obligations that not specifically mentioned are not released by this Specific Release.

The party signing this release has not assigned any claims or obligations covered by this release
to any other party.

The party signing this release intends that it both bind and benefit itself and any successors.


Dated: * , 20 *

*
Signature
*
Printed Name