For good and valuable consideration received, the undersigned being the holder of an actual, asserted or prospective claim against ______________________________________ arising from:

do hereby covenant that I/we shall not commence or maintain any suit thereon against said party whether at law or in equity provided nothing in this agreement constitutes a release of this or any other party thereto.

This covenant shall be binding upon, and inure to, the benefit of the parties, their successors, assigns and executors, administrators, personal representatives and heirs.

The undersigned affixes and seals this __________ day of ________________________, 20____.



Signed in the presence of:



STATE OF _______________

COUNTY OF _____________

On _________________________before me,____________________________, personally appeared _____________________________, personally known to me (or proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature: _______________________________

Affiant ______ Known ______ Unknown ______

ID Produced_________________