Florida DHSMV Release and Repayment Agreement Form
This file contains the Florida Department of Highway Safety and Motor Vehicles Agreement for Release and Monthly Repayment Note. It is essential for suspended drivers and other parties involved in settlement agreements following a crash. Use this form to establish terms of repayment and release from liability.
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How do I fill this out?
Filling out this form accurately is crucial for ensuring compliance with Florida law. Begin by gathering all necessary personal information as outlined in the form. Follow the structured steps provided to complete the form and ensure signatures are notarized.
How to fill out the Florida DHSMV Release and Repayment Agreement Form?
1
Gather your personal and other party's information.
2
Clearly state the terms of the agreement.
3
Ensure all signatures are present and notarized.
4
Keep copies for your records.
5
Submit the completed form as instructed.
Who needs the Florida DHSMV Release and Repayment Agreement Form?
1
Suspended drivers who need to negotiate repayment terms.
2
Insurance companies representing clients after a crash.
3
Attorneys working with clients on settlement agreements.
4
Parties involved in property damage claims.
5
Individuals seeking to reinstate their driver’s license.
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What are the instructions for submitting this form?
To submit the Agreement for Release and Monthly Repayment Note, mail the completed form to the Department of Highway Safety and Motor Vehicles' Bureau of Motorist Compliance at P.O. Box 5775, Tallahassee, FL 32314-5775. You can also contact them at 850-617-2000 for further assistance. It is advisable to use certified mail for tracking purposes.
What are the important dates for this form in 2024 and 2025?
Important dates for the Agreement for Release and Monthly Repayment Note in 2024 and 2025 include deadlines for repayments and signature notarization. Always check for any changes in state legislation that might affect these dates. Ensure your submissions align with these crucial timelines.
What is the purpose of this form?
The purpose of the Florida DHSMV Agreement for Release and Monthly Repayment Note is to formalize the repayment terms between suspended drivers and other parties following a crash. This agreement serves to document the compromise of claims, ensuring that all parties understand their obligations under Florida law. By signing this document, parties agree to the terms outlined and establish a clear process for repayment and liability release.
Tell me about this form and its components and fields line-by-line.
- 1. Last Name: The last name of the suspended driver.
- 2. First Name: The first name of the suspended driver.
- 3. Middle Initial: The middle initial of the suspended driver.
- 4. Suffix: Any suffix related to the suspended driver.
- 5. Current Mailing Address: The full mailing address of the suspended driver.
- 6. City: The city of residence of the suspended driver.
- 7. State: The state of the suspended driver's residence.
- 8. Zip Code: The ZIP code of the suspended driver's mailing address.
- 9. Date of Crash: The date the crash occurred.
- 10. Date of Birth: The suspended driver's date of birth.
- 11. Driver's License Number: The suspended driver's license number.
- 12. Social Security Number: The suspended driver's social security number.
- 13. Financial Responsibility Case Number: The case number related to financial responsibility.
- 14. Location of Crash: The location where the crash occurred.
- 15. Total Amount: The total amount agreed upon for settlement.
- 16. Date of First Payment: The date the first payment is due.
- 17. Frequency of Payment: The agreed frequency of payments.
- 18. Signatures: Area for signatures of both parties, to be notarized.
What happens if I fail to submit this form?
Failure to submit this form can lead to unresolved financial obligations and potential legal issues for the suspended driver. It may result in the continuance of suspended driving privileges and hinder the reinstatement process. To avoid complications, ensure timely completion and submission of the agreement.
- Suspension of Driving Privileges: Ongoing suspension may continue if the form is not submitted.
- Collection Actions: Failure to submit may lead to collection efforts by the other party.
- Legal Consequences: There could be legal ramifications resulting from non-compliance.
- Financial Liability: Not submitting the form could leave the driver liable for full amounts.
- Unresolved Claims: Payment obligations remain unclear and may result in claims.
How do I know when to use this form?
- 1. Post-Crash Settlement: To formalize repayment agreements after a vehicle crash.
- 2. Driver's License Reinstatement: Needed for negotiating payment terms to reinstate a suspended license.
- 3. Insurance Purposes: When dealing with claims related to property or bodily injury.
- 4. Debt Acknowledgment: To acknowledge and document any debts resulting from the incident.
- 5. Legal Documentation: For legal record of mutual agreement between parties involved.
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