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A RELEASE

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A RELEASE Powered By Docstoc
					                                                              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.

				
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posted:3/17/2010
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