
SR-58
General Release
Rev. 03/06
Alabama Department of
Public Safety
Return to:
DRIVER LICENSE DIVISION
SAFETY RESPONSIBILITY UNIT
PO BOX 1471
MONTGOMERY AL 36102-1471
To be executed only when a full release from liability has occurred. THIS RELEASE CANNOT
BE CANCELED. If the notarized release is obtained from the insurance company of the
claimant, a subrogation or proof of loss must be furnished. Release need not be notarized if
properly witnessed by two persons over eighteen years of age and other than the two parties
negotiating the release. Witnesses' address must be furnished.
ACCIDENT CASE NUMBER:
DATE OF ACCIDENT:
COUNTY OF ACCIDENT:
ALABAMA DEPARTMENT OF PUBLIC SAFETY
GENERAL RELEASE
For good and valuable consideration the undersigned does hereby release and forever discharge
the said _____________________________________________ from all claims and causes of
action the undersigned now has or hereafter may have on account of damages resulting from an
accident which occurred at _________________ on or about __________ 20____.
By the execution of this release, the party agrees that the same may be used The Motor Vehicle
Safety Responsibility Unit in the administration of any provision of the Alabama Motor Vehicle
Safety Responsibility Act 704, of 1951.
____________________________________
Signature of Party Giving Release
Sworn to and subscribed before
me this _______________ day
of ______________________
________________________
Notary Public
________________________
My Commission Expires
WITNESS 1:
________________________________
Name
________________________________
Address
________________________________
City, State, Zip Code
________________________________
Name
________________________________
Address
________________________________
City, State, Zip Code
WITNESS 2:
Dated: ___________________, 20________