RELEASE AUTOMOBILE ACCIDENT CLAIMS (TYPE 2)
Release given on (Date), by referred to as Releasee.
, of (Address), here referred to as Releasor, to
, of (Address), here
STIPULATIONS
A. Releasor suffered property damage, personal injuries, and other losses as a result of an automobile collision that occurred on (Date), at (Specific location), involving Releasor’s automobile, driven by Releasor at the time of the accident, and an automobile driven by Releasee.
B. Releasor asserts the collision was caused by the negligence of Releasee. Based on such assertion, Releasor commenced an action for property damages and personal injuries in the (Specify court), Civil Case No. , entitled v . Damages in the amount of Dollars ($ ) as alleged in Releasor’s (Complaint or petition or declaration) in that action are being sought in such litigation.
SECTION ONE RELEASE OF ALL CLAIMS
Releasor understands that he [she] may have suffered injuries that are unknown to him [her] at the present time and that unknown complications may arise in the future from injuries of which he [she] is at present unaware. Releasor acknowledges that the possibility of such unknown injuries and complications was discussed in the course of negotiations leading to agreement on the terms of this release, and the sum to be paid by Releasee hereunder was determined with due regard for such possibility.
With such knowledge, and in consideration of
Dollars ($
), receipt of which is hereby
acknowledged, Releasor elects to and does assume all risks for claims heretofore or hereafter arising, known or unknown, including, without limitation, claims for property damage, direct or indirect medical expense, pain and suffering, disability, and loss of income, based on the automobile accident herein described. Releasor, for himself [herself] and for his [her] heirs, legal representatives and assigns, knowingly releases and forever discharges Releasee and his [her] heirs and legal representatives from all liability with respect to such matters and from all claims and causes of action based in any manner on the accident.
SECTION TWO
electronic form 2005
WWW.LawCA.com Law Publishers
COMPROMISE OF DISPUTED CLAIM
Payment of the sum mentioned in Section One hereof is made by Releasee in compromise of a disputed claim between the parties and is intended to extinguish all rights and liabilities concerning such claim. Payment is not to be construed as an admission of liability by Releasee or anyone else.
SECTION THREE DISMISSAL OF ACTION
Releasor specifically authorizes and directs his [her] attorney, (Name), to execute in duplicate a dismissal with prejudice of the (Complaint or petition or declaration) in the above-mentioned legal action, and to deliver it to (Name of attorney for Releasee), Attorney at Law, whose office is located at (Address, including zip code), contemporaneously with the execution of this release. Thereafter, Releasor shall never assert any claim whatsoever arising from or based on the automobile accident herein described insofar as Releasee is concerned.
SECTION FOUR INSURER TO BE COVERED Releasor intends that this release cover (Name of Releasee’s insurer), an insurance company incorporated under the laws of the State of , and duly licensed to do business in the State of , having its
principal place of business at (Address), and the liability insurance carrier of Releasee.
SECTION FIVE BASIS FOR RELEASE
The consideration stated herein is contractual and not a mere recital. Releasor executes and delivers this release after being fully informed of its terms, contents and effect. Releasor has had the benefit of advice from attorneys and doctors of his [her] own choosing, and no compromise or representation of any kind has been made to Releasor by Releasee or anyone acting in behalf of Releasee. Releasor understands that this is a full, complete and final release of Releasee, and that the sum of Dollars ($ ) mentioned above
is all the money to be paid to him [her] as a result of the herein-described accident and law suit.
In witness whereof, Releasor has executed this release at (Designate place of execution) on the day and year first above written.
electronic form 2005
WWW.LawCA.com Law Publishers
Signature
Date
Witness
Date
Witness
Date
Witness
Date
electronic form 2005
WWW.LawCA.com Law Publishers