TRESPASS AND INSURANCE 1149 



RECEIPT AND DISCHARGE 



Check No. 

 KNOW ALL MEN BY THESE PRESENTS : That. 



The undersigned, in consideration of the sum of $ , and other 



valuable consideration, in hand paid by the , a corporation 



of , , receipt of which is hereby acknowledged, 



do hereby acknowledge full payment, settlement and satisfaction for, and do hereby 



forever discharge the said (company) from any and all 



actions, causes of action, claims and damages of whatsoever kind, nature and 

 character sustained by the undersigned that may have arisen by reason of, or founded 



upon the operation and acts of the (company) , its agents, 



servants and employees in carrying on exploration work, tests, surveys and operations 

 by seismograph or other methods, on, in, over, under or about the following described 

 land, of which the undersigned declare that I/we am/are the lawful owner, situated 

 in the County of , State of , to-wit : 



Dated this day of , 19;.. 



