Case File
efta-efta00787681DOJ Data Set 9OtherPOLICYHOLDER'S RELEASE (For Individuals or Corporations)
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Unknown
Source
DOJ Data Set 9
Reference
efta-efta00787681
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1
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0
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POLICYHOLDER'S RELEASE (For Individuals or Corporations)
McLarens File H008.021055.00
MG Claim #:610421
CLAIM NUMBER
PCG
POLICY NUMBER
IN CONSIDERATION of
One million dollars and no cents
1,000,000.00
and other good and valuable considerations to me paid, the receipt whereof is hereby acknowledged, I,
JEFFREY EPSTEIN
(being of lawful age) do hereby release and
forever discharge
AIG Property Casualty Company, Insurance Office Central Ohio and McLarens and
their respective
successors and assigns, from any and all action, causes of action, claims and demands whatsoever for, upon, or by reason of any damage,
loss or injury and all consequential damage, which heretofore have been or which hereafter may be sustained by me
in consequence of
damage and loss to fine art and jewelry insured under Policy No. PCG 0021940015 caused by
Hurricane Maria and Hurricane Irma in or about September 2017
IT BEING FURTHER AGREED AND UNDERSTOOD, that the payment of said amount is not to be construed as an admission
of liability, but is a compromise of a disputed claim and that this release is executed in full settlement and satisfaction of rights of
the undersigned under Policy No. PCG 0021940015
arising out of Damage and loss
above referred to.
said
WITNESS my/our signature
and seal
this
day of
, 20
Witness
State of
County of
Witness
FOR INDIVIDUALS
On the
day of
CAUTION: READ BEFORE SIGNING
ACKNOWLEDGMENT
State of
County of
Officer
FOR CORPORATIONS
0
SS.:
, 20
On the
day of
, 20
(SEAL)
(SEAL)
before
me
before me came
came
to me known to be the individual described in, and who
to me known, who, being by me duly sworn, did depose and say
executed, the foregoing instrument, and acknowledged
that
that
Executed the same.
s/he resides in
; that
Notary
s/he is the
of
, the
corporation described in, and which executed, the foregoing
instrument; that s/he knows the seal of said corporation; that the
seal affixed to said instrument is such corporate seal; that It was
so affixed by order of the Board of Directors of said corporation;
and that s/he signed her/his name thereto by like order.
Notary
EFTA00787681
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