Fill and Sign the California Disclaimer 497298168 Form

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SUPERIOR COURT OF CALIFORNIA COUNTY OF In Re the Estate of: ) ) ) ) ) ) ) ) )Name of the Deceased NO. RENUNCIATION AND DISCLAIMER OF PROPERTY I. COMES NOW, _____________________, as a party who has succeeded or will succeed to the following property interest of the estate of ______________________________________: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. II. Pursuant to applicable law of the State of California, and the Internal Revenue Code of 1986, if applicable, the undersigned, __________________________, does hereby declare that: ( ) The undersigned completely renounces any and all rights to the entire interest in the above described property. or ( ) The undersigned renounces only a partial interest in the above described property, retaining rights to the remainder of the property. (Describe extent of disclaimer) ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 _________________________________________________________________________________ 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. The property devolves to others pursuant to the provisions of applicable California State law as though the undersigned had predeceased the decedent. As a result of this renunciation and disclaimer, the following individual(s) will take the interest or right to inherit the property or asset of the deceased as described in paragraph IV: _____________________________ _____________________________ _____________________________ 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) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 State of California County of On before me, (here insert name and title of the officer), personally appeared , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) 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 ___________________________________ Print Name _________________________________ Address ____________________________________ ___________________________________________ Telephone _________________________________________ Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ______ day of __________________, 20_____. _______________________________ (Name)_________________________ Personal Representative/Executor/Executrix