A RELEASE IT IS AGREED: That while the automobile described below is in my possession, that my insurance Liability Policy shall bear the Primary Coverage; with the Dealer having Secondary Coverage, until the described vehicle is returned to the Dealer. MAKE MODEL BODY TYPE VEHICLE IDENTIFICATION NO. YEAR PLATE NUMBER STATE YEAR My Insurance Carrier is ___________________________________________________________________________________ Dated this _____________day of ____________________, 20_________ DRIVERS LICENSE # STATE EXPIRES HOME PHONE CELL PHONE CUSTOMER NAME PRINTED_________________________________________________________ SIGNATURE________________________________________________________________________ NOTICE THE ABOVE RELEASE IS REQUIRED BY STATE LAW, §47-580.2. Insurance coverage on vehicles on loan from authorized motor vehicle dealer. During the time a person is operating a motor vehicle with the express or implied permission of an authorized motor vehicle dealer, as defined in Section 562 of this title; such person's motor vehicle liability policy shall have primary coverage with the motor vehicle liability policy of the dealer having secondary coverage until the vehicle is returned. The change in financial responsibility shall be evidenced by a release signed by the person operating the vehicle with the express or implied permission of the dealer with the release to be returned to the person upon the return of the motor vehicle to the dealer. The motor vehicle liability policy of such person shall meet the minimum financial responsibility requirements found in Section 7-324 of this title.