Fill and Sign the Alaska Disclaimer Form

IN THE ____________ COURT FOR THE STATE OF ALASKA AT ____________ ________ IN RE: THE ESTATE OF NAME OF THE DECEASED ) ) ) ) ) ) CaseNo. ____________ ____________ ) RENUNCIATION AND DISCLAIMER ) OF PROPERTY (Intestate Succession) ) ) ) I. Pursuant to the Alaska Statutes, Title 13, Chap. 13.12, Section 13.12.801, the undersigned, __________________________ , chooses to exercise his/her right to disclaim a partial interest or the entire interest in the described property. II. The decedent died intestate on ______________ ______ , 20 ______ and the undersigned has an interest in the described property. III. Pursuant to intestate succession, the undersigned has an interest in the following property: _____________________________ IV. The undersigned attests that the disclaimer of the property interest will be filed no later than nine months after the death of the decedent. - 1 - V. Pursuant to applicable law of the State of Alaska, 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 III. 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 decedent. DATED this ______ day of ____________ , 20 ______ . ____________________________ (Name) - 2 - State of Alaska ____________ Judicial District (or County of ____________ ) The foregoing instrument was acknowledged before me this ______ day of ____________ , ______ by __________________ (signing party) ______ (marital status). ____________________________________ Notary Public Print Name __________________________ Serial Number, if any: _________________ My commission expires: ____________ I certify that on the ______ day of ____________ , 20 ______ , I delivered a true copy of the Renunciation and Disclaimer of Property by personal delivery, registered mail, and/or certified mail to ________________________________________________ (name and address), the personal representative, executor, executrix, or other fiduciary of the decedent. DATED this the ______ day of ____________ , 20 ______ . Signature of Party       Printed Name       Address       City, State, and Zip       Telephone Number - 3 - Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ______ day of __________________ , 20 ______ . _______________________________ (Name)________________ Personal Representative/Executor/Executrix - 4 -