Fill and Sign the California Disclaimer Form

Disclaimer by Beneficiary of all Rights under Trust and Acceptance of Disclaimer by Trustee To: ____________________________________ (Name of Trustee) _______________ _____________________________________________ (Address of Trustee) _____________________________________ (Name of Trustor) ____________________________________________________________ (Address of Trustor) Re: ___________________________________ (Name of Trust) form ed by ____________________________________ (Name of Trustor) for the Benefit of ___________________________________________________ ______________________________________ (Name s of Beneficiar ies ) For reasons that are satisfactory to me and a re known to the other beneficiaries of the T rust created by [e.g., Declaration of Trust of (Name of T rustor) for the benefit of (Name s of B eneficiaries) ] ______________________ ____________________________ ________________________________________________________________________ ________________________________________________________________________ by an inst rument dated ________________________________ (date) , I, ______________ __________________________ (Name of Beneficiary) , of ________________________________________________________________________ ___________________________________ (street address, city, county, state, zip code) , being over twenty -one (21) years of age, do fo rever renounce and disclaim all my (describe interest under trust, e.g., income, sum certain, etc.) _____________________ ________________________________________________________________________ ______________________________________________________________ __________ under that T rust and all right, title, and interest of whatsoever nature given to me by the provisions of that trust instrument. I declare that I will not accept, either at pres ent or in the future, from the Trustee of the Trust or the T rustee 's successors, any portion of the income or principal of the Trust estate or any interest in it which may be sought to be paid to me in accordance with any right, title, or interest which I had at any time before the execution of this disclaimer. Witnes s my signature on this __________________________________ (date) . ___________________________________ (Printed Name of Beneficiary) ____________________________________ (Signature of Beneficiary) State of California County of Orange On ________________________________ (Date) before me, ____________________________________________ (Name of No tary Public ), a Notary Public, personally appeared ____________________________________ (Name of Beneficiary) , personally known to me (or proved to me on the basis of satisfacto ry evidence) to be the person whose n ame is subscribed to the within instrument and ack nowledged to me that he/she ex ecuted the same in his/her authorized capacity , and that by his/her/their signature on the instrument the person executed the instrument. WITNESS my hand and official seal. ______________________________ ____________ __ _ Notary Public Print Name: _____________________ ___________ __ My commission expires: ________________ ___ ____ Ackno wledgement of Receipt of Disclaimer by Trustee The undersigned ____________________________________ (Name of Trustee ), Trustee of the Trust described above, does hereby acknowledge receipt and acceptance of above and foregoing Disclaimer by _____________________________________ (Name of Beneficiary) . Witness my signature on this the _________________________________ (date) . ____________________________________ (Printed Name of Trustee) ____________________________________ (Signature of Trustee) State of California County of Orange On ____________________________________ (Date) before me, _____________________________________________ (Name of Notary Public) , a Notary Public, personally appeared _______________________________________ (Name of Trustee ), personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized cap acity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and of ficial seal. __________________________ ___________ _______ Notary Public Print Name: _____________________ ___________ __ My commission expires: ____________ ______ ________