Dmv Form Fr 229 – Fill Out and Use This PDF

ACCIDENT CASE NO.: _________________________________ DATE OF ACCIDENT: _____________

LOCATION/COUNT: _____________________________________________________________________

DRIVERS: _____________________________________________________________________

This agreement and release entered into this _______ day of ________ by and between ______________________________

of the county of ______________________ , State of South Carolina, hereinafter known as the party of the first part, and

___________________________________ of the county of _____________________ hereinafter known as the party of the

second part, witnesseth:

1.Know all men by these presence that for and in the consideration of the payment to the party of the second part by the party of the first part the sum of ____________________________, which is now on deposit with the South Carolina Department of Motor Vehicles, and the agreement of the party of the second part to accept this said amount in full and final settlement of any and all claims for damages that the party of the second part has against the party of the first part as a result of the vehicle owned by the party of the second part having been struck and damaged by a vehicle driven by the party of the first part at the time of the above numbered and dated accident. The parties hereto do each hereby release each other from any and all claims, liabilities, or causes of action which the parties hereto may have as a result of the above numbered and dated accident.

2.The party of the first part does hereby direct and authorized the South Carolina Department of Motor Vehicles to pay to _________________________________________ the sum of ___________________ which amount has been deposited by the party of the first part with the said South Carolina Department of Motor Vehicles as security to pay for the damages resulting from the above numbered and dated accident.

3.The parties hereto do each hereby bind each of themselves and each of their heirs, executors and administrators to the faithful performances of all the terms, basis, and conditions of this agreement and release.

Witness the hands and seals of the parties on the date and year above written.

Signed, sealed, and delivered in the presence of:

__________________________________________	__________________________________________________
	Party of the first part
__________________________________________	____________________	_____________________
	Driver’s License No.	Date of Birth

__________________________________________________

Party of the second part

Personally appeared before me _________________________________ and ______________________________________

known to me to be the persons whose names are subscribed to the foregoing instrument and which persons have under oath acknowledged to me that they have executed the same for the purposes therein expressed.

Sworn to and subscribed before me

this ____________ day of ______________ 20 ____

__________________________________________ __________________________________________________

Notary Public

__________________________________________ __________________________________________________

Print Name of Notary Public

__________________________________________

RETURN TO: SCDMV

Commission Expires

Financial Responsibility

PO Box 1498

Blythewood, SC 29016-0040