CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR Court Address City/County Located at Case No. vs. Petitioner Respondent GENERAL WAIVER AND RELEASE (CJ § 3-1510 (c) or FL § 4-512 (c)) I, forever discharge Petitioner Respondent Name , hereby release and and any and all other persons from any and all tort claims which I may have relating to this proceeding, and any tort claims that may arise out of this proceeding. This General Waiver and Release is conditioned on the shielding of the court record and compliance with Annotated Code of Maryland, Courts and Judicial Proceedings Article § 3-1510 or Family Law Article § 4-512 as applicable, and shall be void if these conditions are not met. Date Signature Name Address City, State, Zip Telephone No. - Home Telephone No. - Work CC-DC-077 (Rev. 10/2014) American LegalNet, Inc. www.FormsWorkFlow.com