 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。
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2 A7 |( V) f; v u/ H. F2 \# TSettlement Disclosure
* z, x& L% I! f, I+ U: VFinal Settlement( S, [8 a: r) ?
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CAR A:
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% {! J2 S) o$ E. ?7 r% FMaker/Model -. \, v6 H8 P* p( u2 t
Serial (VIN) # -1 X. _2 N( \1 q5 l' R/ c
Plate Number:
" R9 h) p2 \; ^; I. d/ l/ DDriver Name: (called driver A in this document)4 e# h* _2 {! Y/ ?
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CAR B:) Z) R8 W5 o2 S7 G- n
Year -
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Serial (VIN) # -
; w6 o& W# Q1 b; ] U9 X4 j7 APlate Number:
; L2 o% {8 V. Q. O2 eDriver Name: (called driver B in this document)( ?% V# V6 i- j/ V
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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7 T% {/ s1 m- v1 r6 J# _The driver B has paid1 u! a5 c( v2 M( I! r
1. Bumper repair: $( A6 L- O. y) o& b7 O N
2. Other Compensation: $6 C: x2 ^# n9 I3 [5 ?
4 K5 `6 W2 D; _driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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' o2 Z3 g$ l! a* R/ v7 y8 R' YDriver A:
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Signature Date:+ Y; A G0 X' O; d! j* T& E1 y
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Driver B:
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Signature Date:
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Witness:
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Signature Date: |
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