HomeMy WebLinkAboutRuby Green Release
Augusta Richmond GA
DOCUMENT NAME: RU5'1 CS-RE:e:N (jZbL~ASC
DOCUMENT TYPE:
YEAR: dD () 3
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FlLE NUMBER: J Le {3 Y
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RELEASE
I, Ruby Green, hereby specifically release Augusta, Georgia from any and all causes of
action, liability and damages in connection with or arising from Sewer Services at 1302 Perry
Avenue, Augusta, Georgia 30901. This release shall not include any claims arising after the
effective date of this release.
This Release shall inure to the benefit of Augusta, Georgia, its Mayor and Commission, its
elected officials, officers, agents, representatives and its employees. It shall bind Ruby Green and
her heirs and kgal representatives.
I have carefully read the foregoing Release of Liability and know, understand, and affirm the
content hereof.
If you concur with these terms pi ease ackn,owledgt: with your signature'and rl::turn it to mt;, Upon
receipt of this signed acknowledgment, your account will be properly credited.
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Date
I, Ruby Green, futher state that my election for payment is
a lump sum check in the amount of $176.58.
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