CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR Court Address City/County Located at Case No. STATE OF MARYLAND vs. Defendant Address City, State, Zip Telephone No. - Home Telephone No. - Work Form 4-503.2 GENERAL WAIVER AND RELEASE (Criminal Procedure §10-105) I, forever discharge Complainant , hereby release and , and Law Enforcement Agency , all of its officers, agents, and employees, and any and all other persons from any and all claims which I may have for wrongful conduct by reason of my arrest, detention, or confinement on or about . Date This General Waiver and Release is conditioned on the expungement of the record of my arrest, detention, or confinement and compliance with Code*, Criminal Procedure Article, §10-105, as applicable, and shall be void if these conditions are not met. WITNESS my hand and seal this TESTE: day of Month , Year . (Seal) Witness Signature * The reference to "Code" in this General Waiver and Release is to the Annotated Code of Maryland. CC-DC-CR-078 (Rev. 04/2015) American LegalNet, Inc. www.FormsWorkFlow.com