Fill and Sign the Ar Property Form

RENUNCIATION AND DISCLAIMER OF PROPERTY (Intestate Succession) I. Pursuant to the Arkansas Code Title 28, Subtitle 1, Chap. 2, 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 p roperty. 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. V. Pursuant to applicable law of the State of Arkansas, 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 d evolves 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 Re nunciation and Disclaimer is acknowledged this _______ day of __________________________ , 20 _______ . _______________________________ (Name) ___________________________ Personal Representative/Executor/Executrix STATE OF ARKANSAS COUNTY OF ___________________________ On this the _______ day of ________________ ______ , 20 _______ , before me, ___________________________ , the undersigned officer, personally appeared ___________________________ , known to me (or satisfactorily proven) to be the person whose name is/are subscribed to the within instrument and acknowledged that he/she/they executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. _________________________________ 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, return receipt requested, 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