Navigating the aftermath of a motor vehicle accident often feels overwhelming, especially when it involves negotiating settlements and understanding the legal documentation required by state authorities. Among these important documents in Texas is the SR-19 form, a critical piece of paperwork that facilitates the agreement between two parties involved in an auto accident. Specifically, it serves as an installment agreement for settling claims of damages and/or personal injuries that arose from the incident. This form outlines the amount the responsible party, identified as the party of the first part, agrees to pay the affected party or their representative. The document specifies the payment schedule, including the amount per installment and the initial payment due date. Following the completion of the agreed payments, it is stipulated that the injured party will provide a complete and unconditional release from all claims against the initiating party, pertaining to damages or injuries resulting from the accident. Furthermore, the importance of timely filing, indicated by the mention of a reinstatement fee should the driver's license be suspended, underscores the form's role in not just the personal resolution but also in fulfilling state requirements for legal compliance and the restoration of driving privileges. This document thereby effectively becomes a bridge not only for financial settlement but also for legal rehabilitation post-accident.
| Question | Answer |
|---|---|
| Form Name | Sr 19 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | sr 19 form, how to texas sr 19, sr 19, form sr19 045047 |
TO: |
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DEPARTMENT OF PUBLIC SAFETY |
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SAFETY RESPONSIBILITY |
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PO BOX 15999 |
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AUSTIN, TX |
Accident Case No. ______________________ |
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INSTALLMENT AGREEMENT |
As a result of a motor vehicle accident which occurred at _________________________________, Texas, on
___________________________________ __________, the undersigned, hereafter known as party of
(Year)
the first part, does hereby agree to effect settlement of claims for damages and/or personal injuries suffered by
_________________________________________________________________________________________________
hereafter known as the party of the second part, on the following terms:
The party of the first part agrees to pay the sum of ________________________________________)
($ ______________________ ) to the party of the second part or to his/her personal representative at
the rate of $ ________________________ or more per _________________________, first payment
$ ______________________________ due __________________________________, ________.
(Year)
Upon compliance with the provisions of this agreement the party of the second part shall deliver to the party of the first part a complete and unconditional release from all claims and causes of action he/she now has or hereafter may have against the party of the first part on account of damages and/or personal injuries resulting from the accident referred to.
STATE OF TEXAS _____________________________ ) |
Dated ____________________________, _________. |
ss. |
(Year) |
COUNTY OF __________________________________ ) |
___________________________________________ |
|
(Party of the First Part) |
|
TDL # ______________________________________ |
_____________________________________________________, party of the first part, personally appeared before me,
a Notary Public in and for said County, and acknowledged the execution of the above agreement.
My commission expires: |
___________________________________________ |
|
(Notary Public) |
_______________________________________ |
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|
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ACCEPTANCE
I accept the foregoing agreement and acknowledge that I will execute a release in behalf of the party of the first part upon completion of its terms.
STATE OF _________________________________ ) |
Dated ___________________________, _________. |
|
(Year) |
|
ss. |
COUNTY OF _______________________________ ) |
__________________________________________ |
|
(Party of the Second Part) |
__________________________________________________, party of the second part, personally appeared before me,
a Notary Public in and for said County, and acknowledged the acceptance of the above agreement.
My commission expires: |
__________________________________________ |
|
(Notary Public) |
______________________________________ |
|
IF FORM
A $100.00 REINSTATEMENT FEE WILL BE REQUIRED TO COMPLETE COMPLIANCE.