Are you a senior that needs to file Form 19? Maybe you don't know where to start or what documents you need. Maybe the idea of filling out paperwork feels overwhelming. Don't worry, filing your Form 19 doesn't have to be difficult! In this blog post, we'll provide all the information you need and make it easier for seniors like yourself to complete their Form 19 with confidence. Stay tuned as we explain what form 19 is, who can receive benefits by filing it and how long it takes before those benefits are available—it could even be within minutes!
| 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: |
|
DEPARTMENT OF PUBLIC SAFETY |
|
SAFETY RESPONSIBILITY |
|
PO BOX 15999 |
|
AUSTIN, TX |
Accident Case No. ______________________ |
|
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) |
_______________________________________ |
|
|
|
|
|
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.