Free Form Friday: Form Release of Liability

Today our free form is a release of liability.  If for some reason you find yourself at fault for damaging someone else’s property or for causing someone else’s injury, then before you pay for any property damage and/or injuries you are going to want the other person to sign a Release of Liability.  The Release of Liability will ensure that you do not later owe more money if the person you paid becomes unsatisfied with your settlement agreement.

Please know that if you have insurance that would cover your liability (like an automobile insurance policy, homeowner’s insurance policy, etc.), your policy typically contains a provision that requires you to notify your insurance company prior to negotiating a settlement with an injured party.  You can not generally negotiate a settlement and then submit the settlement release to your insurance company for reimbursement.

FORM RELEASE OF LIABILITY

In exchange for receipt of the sum of $_______________, I do release, acquit and forever discharge ____________________ and his or her heirs, executors, assigns, etc., from any liability now existing or existing in the future due to any and all claims or causes of action which I now have or may in the future have for damage to my property, injuries to myself, loss of services, medical expenses, indemnification, contribution, losses or any other damages of any kind, whether such damage or injuries are now known or unknown which occurred as a result of the following incident: ____________________________________.

I fully understand the terms of this settlement and release, and I voluntarily accept the money paid under this settlement and release for the purpose of making a full and final settlement, compromise, settlement and adjustment of my damages, expenses, inconvenience and injuries.  I intend to release all my claims for damage or injury, whether such damage or injury is now known or unknown or exists now or might arise in the future.

I agree and understand that this settlement and release is a compromise of a claim that is being disputed and that the money I am receiving is not to be deemed an admission of fault or liability by the person being released of liability.

I have carefully read this release and settlement prior to signing it, and I know the contents of this release and settlement.  I signed this release and settlement voluntarily as my own free act, and I have not been influenced by any representation of the person being released.

Printed Name: ____________________
Signature: ____________________
Date: _______________

 

State of North Carolina
County of _______________

Personally appeared before me on the _____ day of _______________ (month) __________ (year) the following person ____________________  who acknowledged that they executed the above and foregoing Release of Liability.

Signature of Notary Public: _________________________
My Commission Expires: ____________________