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Before me the undersigned authority on this day personally appeared known to me to be the person and authorized representative whose name is subscribed to the forgoing document and acknowledged to me that the same was the act of and that s he executed the same as the act of said company for the purpose and consideration therein expressed and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF THE OFFICE this day of 20. Company does hereby fully and unconditionally finally release...

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Any individual or organization that has been requested to provide a sworn statement and release of liability may need to complete an affidavit and final release.

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