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Certification Of Release--Financial Responsibility Law
CERTIFICATION OF RELEASE--FINANCIAL RESPONSIBILITY LAW
To: [state motor vehicle department]
[address of state motor vehicle department]
The undersigned, [name of releasor], of [address of releasor], hereby certifies that [he or she] is of the age of [state minimum age] years or older or of the age of [age below state minimum age] years or older and has contracted a lawful marriage and that [he or she] has released [name of releasee], of [address of releasee], from all claims and causes of action of the undersigned arising from an accident that occurred on [date of accident], at [location of accident].
The undersigned authorizes the [title of addressee state motor vehicle department] to accept this certification as satisfactory evidence of the release from liability as required by the [state] Financial Responsibility Law, [statute].
Signature of Injured Person or Owner of Damaged Property Date
[Acknowledgment, if required]