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Brief • June 6, 2005
ofthe sum of _ Twelve Thousal1d, Five Hundred ($12,500.00) Dollars, lawful money ofthe United States, the receipt whereof is hereby acknowledged, for myself, my heirs, executors, administrators ...
Brief • March 22, 2005
acknowledged, for myself, my heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia, a municipal corporation, its officers, agents, servants and employees ...
Brief • 2002
of the sum of Three Thousand and Two Hundred Dollars($3,200.00), lawful money of the United States, the receipt whereof is hereby acknowledged, for myself, my heirs, executors, administrators and assigns, do ...
Brief • 2001
, for myself, my heirs, executors, administrators, and assigns, do release and for~ver discharge the District of columbia, a municipal corporation, its officers, agents, servants, and employees, of and from ...
Brief • 2000
whereof is hereby acknowledged, and for other considerations, for myself, my, heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia, a municipal corporation ...
Brief • September 23, 2002
) Dollars, lawful money of the United States, the receipt wbereofis hereby acknowledged, for myself, my heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia ...
Brief • March 24, 2000
, my heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia, a mun~cipal corporation, its officers, agents, servants and employees, of and from any ...
Brief • April 4, 2006
wlltlrcof is hereby acknowledged, for myself: my heirs, e)teCUfOTS, admin~ators an assigns, do release and forever discb9rge the District of Columbia, a mtmicipal corpomtion, its officetS, gents, s ...
Brief • March 28, 2007
$11,000.00 (Eleven Thousand Dollars) lawful money of the United States, the receipt whereof is hereby acknowledged, for myself, my heirs,executors, administrators: and assigns, do hereby release and forever ...
and the United States District Court for the District of Hawaii. 1 Case 1:11-cv-00144-LEK-BMK Document 191-3 3783 3. Filed 10/16/12 Page 2 of 3 PageID #: I make this Declaration based on my personal ...
Brief • January 4, 2000
of the United States, the receipt whereof is hereby acknowledged, for myself, my heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia, a municipal corporation ...
Brief • May 14, 2001
for consideration of the sum of _ Ten 1'housand Dollars ($10,000.00), lawful money of the United states, the receipt: Hhereof is hereby acknowledged, for myself, my heirs, executors,adrninistrators and assigns, do ...
Brief • April 25, 2003
acknowledged, for myself, my heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia, a municipal corporation, its officers, agents, servants and employees ...
Brief • 2007
, with Social Security Number • • • _for consideration of the sum of one thousand dollars ($1000.00) dollars, lawful money of the United States, the receipt whereof is hereby aclmowledged, for myself, my heirs ...
Brief • 2000
for consideration of the sum of Twenty Thousand Dollars ($20,000.00), lawful money of the United States, the receipt whereof is hereby acknowledged, for myself, my heirs, executors, administrators and assigns, do ...
Brief • 1999
at , for consideration 0: the sum of Seven Thousand Five Dollars {57,SOO.OO}, lawful money of the 'niced Scates. the receipt whereof is hereby acknowledged. for myself. my heirs. executors, administrators a~d assigns, do ...
OUTSTANDING MEDICARE OR MEDICAID LIENS INCURRED AS A RESULT OF TREATMENT FOR THE INJURIES IN THIS MATTER. IN WITNESS WHEREOF, I HA VE HEREUNTO SET MY HAND TIDS 2]DAY OF f-t f,M,{Cfl.·7Y-, 0 2014. CLAIMANT'S ...
Brief • 2000
of Two thousand & no cents ($2,000.00) dollars, lawful money of the United States, the receipt whereof is hereby acknowledged, for myself, my heirs, executors, administrators and assigns, do release ...
Brief • November 5, 2007
, with Social Security Number fOr consideration of the sum of three thousand and no/100 dollars ($3,000.00), . • lawful money of the United States, the receipt whereof is hereby acknowledged, for myself, my heirs ...
Brief • July 23, 1999
, for myself, my heirs, executors, administrators and assigns, do release and forever discharge the District of Columbia, a municipal corporation, its officers, agents, servants and employees, of and from any ...
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