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Motor Vehicle Accident Release (Pennsylvania)

Motor Vehicle Accident Release of Liability Instructions

First Paragraph: Enter the date that this Agreement will be signed. Enter the date as day, month, year for example: 1st day of March, 2022.

Next enter the Releasor’s full legal name and address. The Releasor is the party who suffered the damage and is now releasing the other party from any claims or liability in exchange for compensation or consideration.

Now enter the Releasee’s full legal name and address. The Releasee is the person being released from liability or any claims that the Releasor may have had against him/her.

The Accident: Enter the date that the accident occurred, as well as where it occurred and any other details, such where the damage was on the vehicle. Write in as much detail as possible about the accident in order to be clear as to what is being released. 

Consideration and Release:

Paragraph 1: Enter the amount of monetary compensation being given and how it will be paid, such as via cash, money order, certified check, direct deposit, electronic transfer, etc.… For example: in consideration for the sum of $500 paid via bank check.

Having compensation makes the agreement biding legally. Therefore, some sort of compensation will be needed. If the compensation is not monetary, then enter what that will be, for example 15 hours of violin lessons. Write in not applicable for whichever line does not apply.

Paragraph 5: if the Releasee’s insurance company will be covered by this release, enter the name of the insurance company here. If not, write in not applicable or N/A here.

No Liability:

Paragraph 11: Enter the state that the laws will apply.

Signature:

Both the Releasor and the Releasee will sign this Agreement. Print their names and enter the required information that includes their driver’s license number and phone number.

The Parties may decide to have this Release either Witnessed or to sign in front of a notary public. Although neither is required to make this Release binding, it is still a good idea to either notarize this document or have it witnessed, in case of any future disputes. The Witness and Notary Page are separate and at the end of the document, if you decide to use either one. If not, discard.