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GENERAL RELEASE
TO ALL TO WHOM THESE PRESENTS SHALL COME OR MAY CONCERN,
KNOW THAT, _____________________________________, duly authorized to do
business in the State of New York, with offices located at
_____________________________________________________;
In consideration of the receipt of a __________________, Vehicle Identification Number
___________________ (the "Vehicle"), from the COUNTY OF SUFFOLK, as RELEASEE;
_____________________________________, as RELEASOR, hereby releases and
discharges the RELEASEE, RELEASEE'S agents, servants, employees, heirs, executors,
administrators, successors and assigns from all actions, causes of action, suits, debts, dues, sums
of money, accounts, reckonings, bonds, bills, specialties, covenants, contracts, controversies,
agreements, promises, variances, trespasses, damages, judgments, extends, executions, claims,
and demands whatsoever, in law, admiralty or equity, which against the RELEASEE, the
RELEASOR, the RELEASOR'S heirs, executors, administrators, successors and assigns ever
had, now have or hereafter can, shall or may, have for, upon, or reason of any matter, cause or
thing whatsoever from the beginning of the world to the day of the date of this RELEASE, with
regard to the release of the Vehicle to _____________________________________and the
condition of the Vehicle as of the date and time of the Vehicle's seizure, and further agrees:
The RELEASOR will hold harmless the RELEASEE, the COUNTY OF SUFFOLK, its
agents, servants and employees and indemnify same from any claim or claims that may be
asserted against them and for any damage, expense or cost which the RELEASEE may suffer
with regard to the release of the Vehicle to _____________________________________or any
claims brought by ____________________ regarding the Vehicle's release to
AGENCY NAME
AGENCY ADDRESS
YEAR and MAKE
VIN NUMBER
AGENCY NAME
AGENCY NAME
AGENCY NAME
TITLED OWNER
AGENCY NAME
VIN NUMBER
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_____________________________________ and the condition of the Vehicle as of the date and
time of the Vehicle's seizure.
RELEASOR further agrees not to return the Vehicle to ____________________ unless a
court having proper jurisdiction otherwise orders.
Whenever the text hereafter requires, the use of singular number shall include the
appropriate plural number as the text of the within instrument may require.
This RELEASE may not be changed orally.
In Witness Whereof, the RELEASOR caused this RELEASE to be executed on the ____
day of , 20___
_____________________________________
By: _________________________________
STATE OF _________________, COUNTY OF __________________: ss:
On this day of , 20___, before me, the undersigned,
______________________, personally appeared, personally known to me or proved to me on the
basis of satisfactory evidence to be the individual whose name is subscribed to the within
instrument and acknowledged to me that he/she executed the same in his/her capacity, and that
by his/her signature on the instrument, the individual, or the person upon behalf of which the
individual acted, executed the instrument.
___________________________
NOTARY PUBLIC
AGENCY NAME
TITLED OWNER
AGENCY NAME
AGENCY NAME
VIN NUMBER
AUTHORIZED AGENT NAME and TITLE HERE;
SIGN ABOVE LINE