SPECIFIC RELEASE FOR ONE DOLLAR AND OTHER GOOD AND VALUABLE CONSIDERATION, the undersigned hereby releases, forgives and forever discharges _______________________ ; its successors, assigns and personal representatives from any and all claims or liabilities arising from: Provided however that this release applies only to the foregoing, and no other debt, obligation, agreement or liability by and between the parties, any of which, if existing, shall survive this release. Dated: ______________________________ Form 620