Release Form For Property Damage (Page 2 of 2) in pdf

Release Form For Property Damage Page 2

Instructions

for completing the Agreement for Release and Monthly

Repayment Note:

1. Make copies of this form and mail one to each releaser on your

list. Use certified mail, Return Receipt Requested.

If releaser signs and returns form to you, take the signed releases and your original SR22 form

to your nearest Florida driver’s license office or mail to the address on the front of this letter.

If releaser refuses to sign forms or does not respond to your mailing, you must pay the

security deposit associated with that person. Deposits are held for one year from date of deposit.

After 11 months from the date of deposit, if unclaimed, you will be mailed a letter to your address

on record with instructions on how to claim your deposit. You must complete and return the

request for the deposit to be refunded one year after, but no more than five years, from the date of

deposit. When you pay your security deposit at your local office, you will need to bring any

signed releases and your original SR22 form or mail them to the address on the front of this letter.

If mailing is returned to you undeliverable, take the sealed envelope to your local office to

have the releaser amount reduced to $100.00 for bodily injury and/or $250.00 for property

damage. When you pay your reduced security deposit at your local office, you will need to bring

any signed releases and your original SR22 form.

2. Keep a copy of each Agreement for Release and Monthly

Repayment Note for your records.

Return to: Department of Highway safety and Motor Vehicles

Phone: 850‐617‐2000

Bureau of Motorist Compliance, MS 98

Fax:

850‐617‐5216

Post Office Box 5775

Tallahassee, Florida 32314‐5775

DHSMV Web Site: http//

Release Form For Property Damage Page 2