HomeMy WebLinkAbout29410 / 78-07April 6, ].97�3
,,
o'
I` •�'�
R E V I G' T_�
� 7
I'A�1T Or C�A7N! OF LA�A FL�IAN
i � r� �� : . �. r� - • �•
RESOLU'PTON
j'�E�S, on August 31, 1977s a Noti�e of Injury y,ra,s f�,�,� �� f o£
L-aura �'urn.an � the City of �si�:osh, and .
�'�, it is the rec�rm�datioxi of our insurance adjust�er that �ha�.s
matter be settlad in .th� ��t pf $1,169. 00;
I�z0U7, T�i��E, fi; IT RES�LVID by ths C�n Crn.mci.1. of the C�.-ty of
Oshkwh that the pzo��- �ty offici�ls are h.xeby authorxzed anc� direc� �
PaY the aam�unt of $Il �.,.�a . p� to Lavra F�, �� for this pzxr,�OSe is herebY
apl�ro�nate� fr�;'• �-��1�"?t �To• 012 6g0 Liability Insurance Claim Account.
�----, _.-�.._.�,.�,...��,.r.w,.�_
, -. � r'" � v.'' % rt' ,�.�. ...�.�... �4' r�..5e.....,�
� +
- .��y.,,..�..�..,...<,._. , :
_ ,,„._, ,. f
� � + � �� ., r, . �
_. ____ r ��..�� `�'`�-a,
� r._,:xl. �4��.u. _. �
. .,.�.'�"�'��
_ 7 _
GENERAL RELEASE, HUSBAtdD APID 19VIF�E
KNOW ALL MEN BY THESE PRESENTS:
That we, _���-�� 1L � 1—�-�-�1�='���_ and <' �1� f/ �:
� (Husband) --��- -1---�.--,L" W fe e�i���� _--- -
� ) .
husband and wife, residi�.g at ��`�11 �I>,��i ��• 5;�. _�_ �;�,✓�����_���1C�i���L�
and each being of !awfu� age, for the sole consid�ratic� of
dollars ($ �
to us in hand paid, the receipt whereof is hereby joirtly and severally acknowledged, have remised, released, and forever dis-
charged and by these presents do, severally and jointly, for eurselve; and for our heirs, executors, administrators, and assigns,
do hereby remise, release, and forever discharge �i!J� G� �'"�{ o/` �;!,S"j�j:li'� ��/�E✓(Gd�fSi��
and his, her, their, and i*s successors and assigns, anc each of their heirs, executors, and administrators, and all other persons,
firms, and corporations, eT and from any and all claims, demands, r�ghts, and causes of action, of whatsoever kind or nature,
arising from or by reason of any and all known and unk-own, foreseen and unforeseen bodily and personal injuries, loss and
clamage to property, and the consequences thereof, r�sulting, and to result, from a�G ��7:��-. r�c::.,✓,-`° �,,�hich happened
on or aoout the_�-'-,% i i=/ _day of ;�,i _, 19 �':� at or near 'l ����1. �� L�f�,t� �iGxSi�
.{ � —
It is furfher understcod and agreed that tni; ;e+=>men� is th� comprom'se of doubtful and disputed daims, and that the
payments are not to be construed as an aomissicn of 'abil:�y on the part of ,i -,�1= ����y�;�.= ��,.�fr?Li'7 �;✓�-ii�--�
by Y�hom liabil�=y is express!y denied.
This release cortains the ENTIRE AGREEMENi be-:;een tne parties herefo, and the terms of this release are contractua(
and �ct a mere recital.
We further state that we have carefully read �ne `c-ege'ng re!�ase and know the contents thereof, and we sign the same
as our own free acts.
WITNESS our hands and seals this �_�ay o'_._��" i,�_/� , 19 %�
SIGNED IN THE PRESE;:CE OF
State of_�!.-�� S<" .� `� r j��
�
County of l�< :,�; t,-� t;; �-t-; ,
On the � ? day ot —
' .. ? li, ' j t
CAUTtON: READ BEFORE SIGNING
� �! ' �v', 1'��t_ —(SEALj ; "�`� .
,-��,� _ �,_
—(sEAL� :,; '._ °�
,�;
, 19 r"'�—, before me personafly appeared
, �.
; • . : � �. . . � - -- � -• � ,
; ;—�---�— � � � , %,, and / ;�, � � ;; l' f �. `%' ��1i;'l�,
to me known to be tne �,e-sors who s�gned the foregc�rc ,-elease, and after I had fully explained to'them the nature and legal
effect thereof acknow!edged that ;hey ful�y understanc its contents and meaning and duly executed the same as their free act
and deed and for t��e scf� consideration therein express=�.
IN TESTIMONY WHcREOF, I have hereunto set T� ha^d and affixed my notarial seai on the day and year first above
written.
/ ��
��,,�,j �;,1�,,.,,,�.' "�_�'/•��i';/✓�%;-•``--?
/�1 _. �
My commission exp+�es ��''�-�_<r'4_ :: --- ..�...,_,�7—`--- - Notary Public !--
(If =his rei�ase is acknowledged before a Nc�ary Public, no witnesses' signatures ara necessary.)
UNIFORM STANDARD Fcrr� No, ! 3?55
�iiNif� •iN V,5 �.�• • <.c� r�a.......�..
ti
�
f'"`}
�
r�y 7
\
i�J��
�.�
��
���
a�
� �
0 0
�
� �
� �
a� c�
�
��
��
O �
� �
cd �
O F1 �
-I-� � �
o `� �
rl 4-i cd
-F-� O Fa
r—I � �
O •r-I fCi
v2 c�3 �
a� � �
c� c� �
i i
� �
•� r�
�
�a .
•� +>
a �
�
0 0
O� U
�p U �
N � ^
�-I N
O N �
U •�
� O �.' rl
-�-� ted� 1,
� f�'l T
� �
m �d
•• S a" r-I
�2� H
N ',� +�
� +� a�
a; •rl r-I
�
O
.�
�
0
�
�
�
�
�
�
rd
�
.,-i
�
�t
cd
U
�
�
O
rd
�
0
H
�".
O
.,-r
�
0
�
r--
�
N
�
rd
N
.�
�
�
c�
U
�
ti
�
r-I
�
r--1
��--�
�N
d
�
� �
� �
�
� �
�
-�-.1
�i
U