Form GSA Form 1142 GSA Form 1142 Release of Claims

General Services Administration

RELEASE OF CLAIMS

The undersigned contractor, pursuant to the terms of Contract No.
between the United States of America and said contractor for the

located at
hereby release the United States from any and all claims arising under or by virtue of said contract or any modfication or change thereof except as follows: (Here list any claims against the Government and the amounts thereof.
If none, so state.)

Witness the signature and seal of the undersigned this

day of

CONTRACTOR

WITNESS:
(Print or type)

(Signature)

(Signature)

(Address)

(Official Title)

(Seal)

GSA FROM 1142 (REV. 12-74)