PARTIAL RELEASE
The undersigned, (Company Name) , a corporation duly incorporated under the laws of the State of New York, and authorized to do business in the State of New York, in consideration of payment of disputed work settlement set forth in the counter signed letter between the Department of Transporation and (Company Name) , in order to resolve a dispute and claim associated with Contact D(#) does, for itself, its successors and assigns, hereby partially release and discharge the State of New York, the Department of Transportation of the State of New York and all officers, agents and employees of the State of New York from this claim, demand, account, contract and liability of every kind or nature in law or in equity arising out of and (contract description) . In case any claim shall have been filed by the undersigned with the clerk of the Court of Claims for any such claim arising out of the above described contract work, its performance or completion and acceptance or in any other way connected with the above described contract work, the undersigned further consents that an order may be made by said Court without notice to the undersigned dismissing the claim upon the merits.
IN WITNESS WHEREOF, the _____ day of ______has hereunto set his hand and affixed the seal of his corporation.
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Name and Title
STATE OF / ))
COUNTY OF / )
On this ____ day of ______, 20____, before me personally came______, to me known, who being by me duly sworn, did depose and say that he resides in ______; that he is the ______the corporation described in and which executed the foregoing instrument; that he know the seal of said corporation; that the seal affixed to said instrument was such corporate seal; that it was so affixed by order of the Board of Directors of said corporation, and that he signed his name by like order.
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Notary Public
Please provide two copies of the signed release with the raised seal