ASSIGNMENT OF DAMAGE CLAIM
BE IT KNOWN, for value received, the undersigned hereby unconditionally and
irrevocably assigns and transfers unto
(Assignee) and its successors, assigns and personal representatives, any and all claims, demands,
and cause or causes of action of any kind whatsoever which the undersigned has or may have
arising from the following:
The Assignee may in its own name, at its own expense, and for its own benefit prosecute
said claim and collect, settle, compromise and grant releases on said claim as it in its sole
discretion deems advisable, provided the undersigned shall reasonably assist and cooperate in
the prosecution of said claim to the extent required or requested. Assignee shall be entitled to all
judgments, awards and payments thereon.
The undersigned warrants it has full right and authority to assign this claim and that said
claim is free and clear of any lien, encumbrance or other adverse interest. Assignor disclaims
any representation as to the merits or collectibility of such claim.
This assignment shall be binding upon and inure to the benefit of the parties, their
successors, assigns and personal representatives.
In the presence of: