RELEASE OF DAMAGES.
State of __________, county of __________, town of __________, ss.:
Whereas, a road was laid out (or altered or discontinued) on the _____ day of __________, A.D. 18_____, by the supervisors of the said town of __________, on the petition of (six) legal voters, owning real estate, or occupying real estate under the homestead or pre-emption laws of the United States, or under contract from the state of __________, within one mile (or eight legal voters freeholders and residents of the town within two miles) of said road; which said road (or alteration, or discontinuance) is set forth and described in the supervisors' order, as follows, viz.: Beginning (describe the road as in the order laying it out); which said road passes through certain lands owned by us as described below:
Now, therefore, know all men by these presents, that we, the owners of the lands described below, for value received, do hereby * release all claims to damages sustained by us by reason of the laying out (or altering, or discontinuing) and opening said road through our lands, viz.: (Here give a description of the lands and their owners' names.)*
In witness whereof, we have hereunto set our hands and seals this day of __________, A.D. 18_____. (Signatures and seals.) Signed, sealed and delivered in presence of two witnesses.