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Form #836Claim Against Railroad Company
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Claim Against Railroad Company Free Legal Form
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Claim against railroad
company.
For the Sole Consideration of $_____ to me (us) which
I acknowledge receiving, I (we) release, acquit, and forever discharge
_________ Railroad Company, its lessors, lessees, licensors, licensees, and any
and all lines or companies owned, operated or controlled by or allied with it,
their agents, servants and employes, and each of them, together with their and
each of their, successors and assigns and all others, from all claims, demands,
suits, actions, causes of action, and damages which I (we) now, or may, can or
might have against them, or any of them, in consequence, directly or indirectly
of any matter or thing done or omitted or suffered to be done by any of them
prior to and including the date of this agreement, and more especially on
account of the death of _________, who was fatally injured on or about
_________[date] near _________ in _________ County, _________, when
riding in an automobile which was struck on a grade crossing by a train of the
_________ Railroad.
This settlement being in full and complete settlement
and release of any and all claims I now have, or may have on account of that
accident, and is in full settlement of all other claims to and including the
date of this agreement.
And for this consideration, it is covenanted by the
undersigned that no suit of any kind or character shall be instituted for a
recovery of any sort against the Railroad Company or any of the parties
mentioned in this agreement, each and all of whom expressly deny all liability
to the undersigned, on account of the occurrence in question, or on account of
any other matter or thing done or omitted or suffered to be done by any of the
parties prior to and including this date; and this release and covenant shall
be forever binding upon the undersigned, as well as upon the heirs,
administrators, executors, successors and assigns of the undersigned.
It is acknowledged by the undersigned that the sum of
money was and is the sole consideration for this release and covenant and that
no promise of any kind, and no representation of fact or opinion has been made
by any of the above named parties, or anyone on their behalf, to induce this
settlement, and that this instrument expresses all the agreements and
understandings between the undersigned and the parties above mentioned; and
this settlement is in all respects complete and final.
Signed and sealed this _________[date] at
_________, _________.
/s/
_________(Seal),
As Administrator of the
Estate
of _________, Deceased.
(Seal)
Executed in the presence of:
/s/ _________
/s/ _________
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not be construed as legal advice. You are strongly encouraged to consult competent
legal council before engaging in any action based upon content contained on this
site.
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or any other commercial use is prohibited. This includes reposting forms from this
site to another site offering free legal or other document forms for download.
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form, and you agree to abide by these terms. It is highly recommended that you have
a licensed attorney review any legal documents for which you are searching in order
to make sure that your needs are being properly and completely satisfied.
Your use of this site constitutes your acceptance of our terms of use and your agreement
to hold this site, its officers, employees and any contributors to this site harmless
for any damage you might incur from your use of any submissions contained on this
site. If you do not agree to the above terms, please do not proceed.
These forms are provided to assist business owners and others in understanding important
points to consider in different transactions. They are offered with the understanding
that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com
is not engaged in recommending or referring members on the site or making claims
about the competence, character or qualifications of its participating members.
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Keywords: legal forms, claim, railroad company
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