Release of Interest in Property

TO: Name of the Registered Owner(s) of Property (the "Owner")

RE: Address of Property (the "Property")

IN CONSIDERATION of the payment by the Owner to the undersigned of the sum of ten
dollars ($10.00) and for other good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged, the undersigned hereby releases and quit claims in favour of the
Owner any and all right, title, interest claim and demand both at law and in equity that it may have
to the Property, for the Owner to have and to hold all interest in the Property hereafter.

This Release shall enure to the benefit of the Owner and his heirs, executors, legal representatives,
successors and assigns.

Dated Date of Release.

Name of Party Releasing Interest

STATE OF STATE
COUNTY OF COUNTY

On Date of Statement (ie. July 1, 2000) before me, Full Name of Notary Taking Sworn Statement,
personally appeared Full Name of Person Signing Release, personally known to me (or proved to me on
the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument
and acknowledged to me that he executed the same in his authorized capacity, and that by his signature
on the instrument the person executed the instrument.

WITNESS my hand and official seal.

Signature