General Release Form Ny - *state of , county of , ss: *(or insert district of columbia, territory, possession or foreign county) on the day of in. This release pertains to personal injuries sustained from an accident which occurred on [date of accident or occurrence].
*(or insert district of columbia, territory, possession or foreign county) on the day of in. *state of , county of , ss: This release pertains to personal injuries sustained from an accident which occurred on [date of accident or occurrence].