Florida Department of Highway Safety and Motor Vehicles · Florida state form
HSMV-74036 Agreement for Release and Monthly Repayment Note
Use HSMV-74036 to document a release and monthly repayment agreement between a suspended driver and another party following a crash.
- What this form is
- HSMV-74036 records a suspended driver’s personal information and the other party’s details, the amount and schedule of payments, and signatures agreeing to the release and repayment terms. The form states that both signature boxes must be signed and notarized for the release to be complete. Its instructions explain how to distribute the form and return signed releases.
- Who needs it
- A suspended driver and the other party, or the other party’s representative, may use this form to document a crash-related release and repayment agreement.
- Why it needs a notary
- Both signature boxes must be signed and notarized; the form states the release is void unless all signatures are notarized. Online notarization is available with a commissioned online notary.
- How to submit it
- The instructions say to mail a copy to each releaser using certified mail, return receipt requested. Take signed releases and the original SR22 form to a driver’s license office or mail them to the agency address shown on the form.
Questions
What is HSMV-74036 used for?
The form documents a release and monthly repayment agreement between a suspended driver and another party. It includes crash, party, payment, and signature information.
Does HSMV-74036 need to be notarized?
Yes. The form says both signature boxes require signatures and notarization, and that the release is void unless all signatures are notarized. A commissioned online notary can notarize it online.
How do I return signed releases?
The instructions say to take signed releases and the original SR22 form to a driver’s license office or mail them to the agency address printed on the form.