 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。, x! ?1 y# V; k3 O2 i7 b
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Settlement Disclosure5 E2 J, L0 k# Z+ y: O$ ^& z( S$ \
Final Settlement
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@6 @5 U4 X1 fCAR A:6 s: ]4 ]0 I# L0 k( L2 H0 k& Z0 S/ L4 I
Year -
( t1 `7 T' Z& W6 u9 g; d& nMaker/Model -1 F }8 e! J( ^; s; y& S6 V' Y
Serial (VIN) # -
0 j; X) k+ d$ @% G, FPlate Number:7 M7 C7 g& d0 S/ Z
Driver Name: (called driver A in this document)
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3 C$ u0 g; e% Y. X9 d$ FCAR B:, i: {( Q0 M/ W! b! e+ m# L
Year -4 Q0 p/ F- V a3 z
Maker/Model –
- |* s% ]! ?8 ^ r, Z1 y; bSerial (VIN) # -" W: X& d: p- u6 M1 B
Plate Number:
4 I, w1 f% n) L9 F# j: i' j% {Driver Name: (called driver B in this document): B6 O6 _6 Y g, |! J
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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: p' `8 ]+ i+ a3 D5 A* B# ]4 CThe driver B has paid
2 V6 W7 y9 J) Y. U# W1. Bumper repair: $
% f1 U5 U' A4 L' A: B0 h! ]* b2. Other Compensation: $' P; d/ ~0 z- l; G
" u5 _3 M( s' B* q: @driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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0 s$ b7 K1 j- S. X' ~' p. aDriver A:
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5 _ A, H* o: N0 T1 R1 ]% lSignature Date:+ J4 k% A( p l/ {1 }- t
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Driver B:
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Signature Date:& n) X' o0 O, m+ |0 z" j
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' g( x4 _" f1 C: k8 ^+ wWitness:; Y. T. S) a& v3 s! G4 v- i
' J& P6 ~. c# l* Y; ^Signature Date: |
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