Property Damage Release Form

1. First Name   Last Name   Releasor, voluntarily and knowingly executes this release with the intention of eliminating Releasee's liabilities and obligations as described below. 
2. Releasor hereby releases   1   , Releasee, from all liability for claims, known and unknown, arising from property damage sustained by Releasor in a property damage that occurred on   2   at   3involving a vehicle owned by Releasee, or driven by Releasee or his/her agent. 
3. This release applies only to property damage and does not apply to any claim for personal injuries, physical or emotional, which Releasor had, has, or may have as a result of the accident described in Clause 2. 
4. By executing 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 Clause 7. 
5. Releasor understands that Releasee does not, by providing the consideration described below, admit any liability or responsibility for the accident described in Clause 2 or its consequences. 
6. Releasor has received good and adequate consideration for this release in the form of    3 .
7. In executing 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 Clause 2 to any other party. This release applies to Releasee's heirs, legal representatives, insures and successors, as well as to Releasee. 
8. This release was executed on   5   , 30   6   at   7   .

Releasor's Signature:   Signature   

Releasor's Address:   Street Address   Address Line 2   City   State   Zip   

Releasee's Signature:   Signature    

Releasee's Address:   Street Address   Address Line 2   City   State   Zip    

Witness Name:   First Name   Last Name    

Witness Signature:   Signature