Release Of Claims

In consideration of the sum of [amount] _________________ Dollars, ($ ________ ), the receipt of which is hereby acknowledged, [name of creditor] _____________________ of [address] _____________________ , City of __________________ , County of ___________________ , State of ____________________ , does hereby release and discharge the estate, administrator, executor and heirs of the decedent from any and claims that [name ofcreditor] _____________________ has or may have in the future against the estateof [name of deceased] _____________________ , deceased.

Dated: _____________

_____________________

[Signature]

[Acknowledgement]