alabama SR31 Safety Responsibility Claim Form pdf
alabama SR31 Safety Responsibility Claim Form pdf, Sr 31 Form pdf, Sr 31 application pdf, Sr 31 Form download, Sr 31 form alabama, Sr 31 form pdf state of alabama,
SR-31 A LABAMA L AW E NFORCEMENT A GENCY D RIVER L ICENSE D IVISION 201 S OUTH U NION S TREET , S UITE 300 / P.O. B OX 304115 / M ONTGOMERY , AL 36130-4115 P HONE 334. 676.6000 / ALEA . GOV ACCIDENT CLAIM FORM MA IL TO: Alabama Law Enforcement Agency Safety Responsibility Unit P.O. Box 1471 Montgomery, AL 36102-1471 Information and Instructions : Comp letion of this form is required ONLY if a mo tor ve hicle accident occurri ng in Alabama, caused death, pe rsonal i njury , or p roperty damage to a ny o ne owner in e xcess of $ 500 by a n uninsured motorist. You can onl y file this form if you have no t b een compensated for your i njuries or losses. ALEA A cciden t Case No. _________________________________ __ Dat e of A cciden t ____________________ AT FAULT DRIVER INFORMATION Driver’s N ame : _______________________________________________________________________________ Driver’s License State: ___________________________ ___ Driver’s License No . ________________________ PERSON AND / OR COMPANY MAKING CLAIM Name: _______________________________________________________________________________________ Address: _____________________________________________________________________________________ City: _____________________________ _ State: __________________________ ___ Zip: _________________ Phone No . _________________________ _ Email Address: ____________________________________________ PROPERTY DAMAG E CLAIM (OWNER ONLY) I, ___________________________, certify t hat dam ages to m y vehi cle and / or p roperty am ounted t o $_________________, as a result of this motor vehicle accident. I believe myself entitled to recovery of the above amount from ________________________ _______________ ( driver ) and I have not released said party. Signature of Owner: ________________________________________________ Date: _______________________ (Must have title of person if signing for company and/or attorney ) ****************************************************************************** INJURY CLAIM (DRIVER AND / OR PASSENGER) I, ______________ ______________ , certify that as a res ult of this mo tor vehicle accident, my medical expenses are $________________. I believe myself entitled to recovery of the above amount from ________________________, ( driver ) and I have not released said part y . Signature of Injured Party: ____________________________________________ Date: ______________________ (I Min f or, sign a of ture legal guardian) Rev 11/18/2021
