"Release Form From the Parent/Guardian of a Minor" - Nebraska

Release Form From the Parent/Guardian of a Minor is a legal document that was released by the Nebraska Department of Motor Vehicles - a government authority operating within Nebraska.

Form Details:

  • Released on January 1, 2007;
  • The latest edition currently provided by the Nebraska Department of Motor Vehicles;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Motor Vehicles.

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Download "Release Form From the Parent/Guardian of a Minor" - Nebraska

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RELEASE FORM FROM THE PARENT/GUARDIAN
OF A MINOR
SUSPENDED DRIVER’S PERSONAL INFORMATION (Please Print):
nd
rd
Last Name
First Name
Middle Initial
Suffix (Jr., Sr., 2
, 3
)
Current Mailing Address Required (Street or PO Box)
City
State
Zip Code
DATE OF BIRTH
DRIVER’S LICENSE NUMBER
SOCIAL SECURITY NUMBER (OPTIONAL)
Month
Day
Year
DATE OF LOSS / ACCIDENT
LOCATION OF LOSS / ACCIDENT
Month
Day
Year
TERMS OF RELEASE:
For valuable consideration received, the undersigned, being the parents or legal guardian of the minor child named below,
hereby releases and forever discharges the suspended driver for all claims (property damages and/or personal injuries)
and/or causes of action arising from the motor vehicle accident listed above.
Name of minor:
Relationship to minor (mother, father, guardian, etc.):
Release to include (circle applicable):
Damage
Injury
Both
Date payment received:
SIGNATURE BELOW MUST BE EITHER WITNESSED OR NOTARIZED:
Other Party (individual, insurance company, attorney, etc.) Signature:
Date:
Witness Signature (Must be a non-interested party):
Notary:
State of ________________________
County of ______________________
The foregoing instrument was acknowledged before me this _______ day of __________________, 20_____ by:
__________________________________________
Name of other party or representative
________________________________
Notary Public Signature
↑Affix seal here↑
Note: Release is VOID unless all signatures are either witnessed or notarized.
RETURN TO:
Department of Motor Vehicles
Phone:
(402) 471-3985
Financial Responsibility Division
Fax:
(402) 471-8288
P.O. Box 94877
Lincoln, Nebraska 68509-4877
DMV Web Site: http://www.dmv.state.ne.us
Neb. Rev. Stat. 60-510(4)
REV 01/2007
RELEASE FORM FROM THE PARENT/GUARDIAN
OF A MINOR
SUSPENDED DRIVER’S PERSONAL INFORMATION (Please Print):
nd
rd
Last Name
First Name
Middle Initial
Suffix (Jr., Sr., 2
, 3
)
Current Mailing Address Required (Street or PO Box)
City
State
Zip Code
DATE OF BIRTH
DRIVER’S LICENSE NUMBER
SOCIAL SECURITY NUMBER (OPTIONAL)
Month
Day
Year
DATE OF LOSS / ACCIDENT
LOCATION OF LOSS / ACCIDENT
Month
Day
Year
TERMS OF RELEASE:
For valuable consideration received, the undersigned, being the parents or legal guardian of the minor child named below,
hereby releases and forever discharges the suspended driver for all claims (property damages and/or personal injuries)
and/or causes of action arising from the motor vehicle accident listed above.
Name of minor:
Relationship to minor (mother, father, guardian, etc.):
Release to include (circle applicable):
Damage
Injury
Both
Date payment received:
SIGNATURE BELOW MUST BE EITHER WITNESSED OR NOTARIZED:
Other Party (individual, insurance company, attorney, etc.) Signature:
Date:
Witness Signature (Must be a non-interested party):
Notary:
State of ________________________
County of ______________________
The foregoing instrument was acknowledged before me this _______ day of __________________, 20_____ by:
__________________________________________
Name of other party or representative
________________________________
Notary Public Signature
↑Affix seal here↑
Note: Release is VOID unless all signatures are either witnessed or notarized.
RETURN TO:
Department of Motor Vehicles
Phone:
(402) 471-3985
Financial Responsibility Division
Fax:
(402) 471-8288
P.O. Box 94877
Lincoln, Nebraska 68509-4877
DMV Web Site: http://www.dmv.state.ne.us
Neb. Rev. Stat. 60-510(4)
REV 01/2007