40 SETTLEMENT FOR ACCIDENTS TO AMERICAN SEAMEN
release, and forever discharge the said ———— ~——— their successors and assigns,
the several steamships of the said companies, their officers and crews, their
heirs, executors, administrators, and assigns, and in particular the steamship
— — of and from all, and all manner of actions, suits, liens, debts, dues, trespasses,
 damages, injuries, wages, sums of money, controversies, agreements,
claims, and demands whatsoever, in law or in admiralty, which against any one
or more of said companies, or against any steamship thereof, or running in said
lines, I ever had, now have or may have, for, upon, or by reason of any matter
or thing whatsoever, from the beginning of the world to the date of these presents;
and particularly, but not exclusively, for all losses, injuries, or damages.
In witness whereof I have hereunto set my hand and affixed my seal the —
day of —— in the year one thousand nine hundred and ——.
Sea and delivered, in the presence of

STATE OF ———,
County of ———, ss:
On the —— day of ———, in the year one thousand nine hundred and ——,
before me personally came ——— ———— to me known and known to me to
be the individual in and who executed the foregoing instrument and —— acknowledged
 that —— executed the same.
RELEASE _PAID BY DRAFT No.______
DISTRIBUTION: : : TT
emma m——————— Rm mmm AE Cin mbm mmr rm mo mm me OCCUPATION:

He

THIS RELEASE MUST EXPRESS THE WHOLE CONSIDERATION
WHEREAS, oo connsny $18 UNACTSIENON creo msmomasim cme eters smssemsm sts essere rm
vw wm- have a claim against the Company of

I
for damages growing out of...

Werniriarisseen

which claim on have acreed to cettle for the sum of -

v -*

eosin LION ATS

Now, therefore, in enmsideration of aid navment. the receipt whereof is hereby acknowledged. ™....ooeecimianie

morn NOPEDY COMPromise-said claim, and acquit, discharge, and refease said Company, and any other person or companies
that may be liabie therefor, their officers, agents, and employe ts, of and from any and all liability for said accident and injury,
or any results direct or indirect, arising therefrom, and acknowledge full accord and satisfaction therefor.
And T hereby expressly state that the above’ consideration is in fi'l for this release. and that there is no understanding
or agreement of any kind for any further or future consideration whatsoever, imnlied, exvected. or to come to me, in money,
employment. or otherwise. 3
I furth-r represent and covenant that before signing and sealing this release and receiving said pavment. I was fully
informed of its contents and execute it with full knowledee thereof.

Witness my hand and seal. this——————dav of......o.ans cos coammmensomrns s0 mefhe I 1920 BY eee em
WITNESSES

rm sn 3 €8)

at smn mi me wom]
*Insert here any other consideration there may be: for example. “and of the promise of frec medical treatment by the Com-PANY'S
 SUIRCON-ceuuaoecmmcncmancacamemamuneananssw80 ONE 38 he may decom it necessary,” or “as well as of payments heretofore made by
the Company for my account, and of the promise by the Company to pay physician's and nurse's bills alreadv incurred by me.
amounting 20 $eeeomeemeeomecanceo”
ERTIES TO Taam a aa