RELEASE-AUTOMOBILE ACCIDENT CLAIMS (TYPE 1)

In consideration of _____________ Dollars, receipt of which is hereby acknowledged, I, _____________________________________________ (name), of _______________________________________ (address), on behalf of myself and my heirs, legal representatives and assigns, hereby release __________________________ (name of tortfeasor), of ___________________________________________________ (address) (if applicable, insert here:  and ________________ (his or her) heirs and legal representatives), from all liability, claims, demands, costs, charges and expenses incident to property damage and personal injuries sustained by me in an automobile accident that occurred on __________ (date), at _____________________________ (insert specific location of accident), involving an automobile being driven by ____________________________________________________ (tortfeasor). This release covers all claims that I had, now have, or may have in the future, known or unknown, against ______________________________________________________ (tortfeasor) (if applicable, insert here:  and ___________ (his or her) heirs or legal representatives), based on the above-described accident.

In addition, I promise not to assert against __________________________________ (tortfeasor), (if applicable, insert here:  and _______________ (his or her heirs or legal representatives), in any court of law, any claim or claims that I had, now have, or may have in the future, known or unknown, based on the injuries sustained by me in the above-described accident. 
 
By executing this instrument I do not waive or relinquish any claim or claims that I may now or hereafter have against any person, firm or corporation other than ______
______________________________(tortfeasor), the Releasee and Covenantee named herein.  I understand that _____________________________ (tortfeasor) does not, by 
making the payment set forth above, admit any liability or responsibility for the above-described accident or the consequences thereof. 
 
In witness whereof, I have executed this release and covenant not to sue at __________
_________________________ (designate place of execution) on __________ (date). 

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