ERS ONL TN Y DAMAGES AND IIIJURJES CAUSED BY THE INCIDENT ABOVE AND AGREE TO ACCEPT SAID AMOUNT IN FINAL SETTLEJAENT OF S CLARA 1Se.S/GNATURE OF MAIMANT (See Instructons on reverse side). 134. PHONE NUMBER OF PERSON SIGNING FORM 14. DATE OF SIGNATURE 02/09/2024 I Iftt/k an. PENALTY FOR PRESEKUNG