NOTICE OF RESCISSION OF RELEASE

TO ____________________________

Notice is hereby given that the undersigned,______________,
rescinds that certain release executed by him on [date]   ,
whereby he released you from any and all claims arising out
of [subject for which release was executed], on the
following grounds:

The undersigned agrees to restore to you total consideration
received by you for his execution of the release, including
[consideration received].

Dated:                                    [Signature]