Vehicle Accident Release of Liability Form

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500
VEHICLE ACCIDENT RELEASE OF LIABILITY FORM  
  
  
I. The Parties. I, _____________________, with a mailing address of  
_____________________, City of _____________________, State of  
_____________________, Hereinafter the “Releasor”, hereby voluntarily and knowingly 
sign this release with the express intention of eliminating _____________________, 
with a mailing address of _____________________, in the City of  
_____________________, State of _____________________, Hereinafter the  
“Releasee”, of their liabilities and obligations as described below.  
  
II. 
Release. Releasor hereby releases Releasee from all liability for claims, known 
and unknown, arising from property damage sustained by Releasor in an accident that 
occurred on _____________________, 20____ at ____:____ ☐ AM ☐ PM involving a 
vehicle owned by Releasee or driven by Releasee or Releasee's agent. Releasor 
understands that, as to claims that are known to the parties when the release is 
signed, any statutory provisions that would otherwise apply to limit this general release 
are hereby waived. Releasor also understands that this release extends to claims 
arising out of this incident that are not known by Releasor at the time this release is 
signed.  
  
III. 
Right to Claims. By signing this release, Releasor does not give up any claim 
that he or she may now or hereafter have against any person, firm, or corporation 
other than Releasee and those persons and entities specified in Section I.  
  
IV. 
Non-Admission of Liability. Releasor understands that Releasee does not, by 
providing the value described in Section V, admit any liability or responsibility for the 
accident described in Section II or its consequences.  
  
V. 
Payment. Releasor has received good and adequate value (consideration) for 
this release in the form of: $ _____________________ (US Dollars).  
  
VI. 
Binding Arrangement. By signing this release, Releasor additionally intends to 
bind his or her spouse, heirs, legal representatives, assigns, and anyone else claiming 
under him or her. Releasor has not assigned any claim arising from the accident 
described in Section II to any other party. This release applies to Releasee's heirs, 
legal representatives, insurers, and successors, as well as to Releasee.  
  
  
Releasor’s Signature ______________________ Print Name ___________________  
  
Date _______________________  
  
 
Releasee’s Signature ______________________ Print Name __________________  
  
Date _______________________