Fill and Sign the 89 21 3 Right to Disclaim Interest in Property Justia Law Form

IN THE __________ COURT OF ____________ COUNTY, MISSISSIPPI In Re the Estate of Cause No.___________________Name of Deceased RENUNCIATION AND DISCLAIMER OF PROPERTY I. Pursuant to the Mississippi Code, Title 89, Chapter 021, the undersigned, _______________, chooses to exercise his/her right to disclaim ( ) a partial interest or ( ) the entire interest in the described property. II. The undersigned has an interest in the property in the above-captioned estate of ____________________ (decedent) who died on _____________________________. III. The undersigned attests that the disclaimer of the property interest will be filed no later than nine months after the death of the decedent. IV. Pursuant to the provisions of paragraph ___________ of decedent's last will and testament dated _____________________ (the "Will"), ______________ is entitled to receive the following property: __________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________ V. Pursuant to applicable law of the State of Mississippi, and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounces and disclaims any interest or right to the property or asset of the deceased described in paragraph IV. VI. The property devolves to others pursuant to the provisions of applicable State law as though the undersigned had predeceased the decedent. VII. This renunciation and disclaimer shall for all purposes be deemed to relate back to the date of decedent's death and is an irrevocable refusal to accept that property effected hereby, and is hereby delivered to the personal representative, executor or executrix of the Estate of _____________________ to be filed with the court in the above-captioned proceeding.DATED this ____________ day of __________________, 20_______. _________________________ (Name) Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this _________ day of __________________, 20_______. _______________________________(Name)________________Personal Representative/Executor/Executrix STATE OF MISSISSIPPICOUNTY OF _________________ Personally appeared before me, the undersigned authority in and for said county and state, on this __________ day of ___________________________, _________, within my jurisdiction, the within named ______________________________, who acknowledged that (he/she/they) executed the above and foregoing instrument. ______________________________Notary Public Printed Name: _________________ My Commission Expires: _____________________I certify that on ____________ ___________, 20_______, I delivered a true copy of the Renunciation and Disclaimer of Property by ( ) personal delivery, ( ) registered mail, and/or ( ) certified mail to the personal representative/executor/executrix or other fiduciary of the decedent. DATED this _________ day of _________, 20_________. _________________________________Signature_________________________________Print Name_________________________________Address_________________________________City, State, Zip Code_________________________________Telephone