California renunciation and disclaimer of individual retirement account annuity or bond california form
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Prepared by U.S. Legal Forms, Inc.
Copyright 2016 - U.S. Legal Forms, Inc.
STATE OF CALIFORNIA
RENUNCIATION AND DISCLAIMER OF PROPERTY
Control Number – CA - 07 - 03
- 1 -
NOTES ON COMPLETING THESE FORMS
The form(s) in this packet contain “form fields” created using Microsoft Word. “Form fields”
facilitate completion of the forms using your computer. They do not limit you ability to print the
form “in blank” and complete with a typewriter or by hand.
It is also helpful to be able to see the location of the form fields. Go to the View menu, click on
Toolbars, and then select Forms. This will open the forms toolbar. Look for the button on the
forms toolbar that resembles a “shaded letter “a”. Click in this button and the form fields will be
visible.
By clicking on the appropriate form field, you will be able to enter the needed information. In
some instances the form field and the line will disappear after information is entered. In other
cases it will not. This is appropriate and the way the form is designed to function.
- 2 -
DISCLAIMER
These materials were developed by U.S. Legal Forms, Inc. based upon statutes and forms for the
State of California. All Information and Forms are subject to this Disclaimer: All forms in this
package are provided without any warranty, express or implied, as to their legal effect and
completeness. Please use at your own risk. If you have a serious legal problem we suggest that
you consult an attorney. U.S. Legal Forms, Inc. does not provide legal advice. The products
offered by U.S. Legal Forms (USLF) are not a substitute for the advice of an attorney.
THESE MATERIALS ARE PROVIDED "AS IS" WITHOUT ANY EXPRESS OR IMPLIED
WARRANTY OF ANY KIND INCLUDING WARRANTIES OF MERCHANTABILITY,
NONINFRINGEMENT OF INTELLECTUAL PROPERTY, OR FITNESS FOR ANY
PARTICULAR PURPOSE. IN NO EVENT SHALL U. S. LEGAL FORMS, INC. OR ITS
AGENTS OR OFFICERS BE LIABLE FOR ANY DAMAGES WHATSOEVER
(INCLUDING, WITHOUT LIMITATION DAMAGES FOR LOSS OF PROFITS, BUSINESS
INTERRUPTION, LOSS OF INFORMATION) ARISING OUT OF THE USE OF OR
INABILITY TO USE THE MATERIALS, EVEN IF U.S. LEGAL FORMS, INC. HAS BEEN
ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
- 3 -
SUPERIOR COURT OF CALIFORNIA
COUNTY OF
In Re the Estate of:
)
) NO.
)
)
Decedent )
)
RENUNCIATION AND DISCLAIMER OF PROPERTY
(Individual Retirement Account, Annuity, or Bond)
____________________________________________________________________________
I.
Pursuant to the California Probate Code Div. 2, Part 8, Chap. 2, the undersigned,
______________________________ , has an interest in an Individual Retirement Account,
and/or an Annuity, and/ or a Bond. The identifying account and/or bond information is as
follows:
II.
The undersigned has an interest in the property in the above-captioned proceeds of
______________________________ (the 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.
Renunciation and Disclaimer of Property - 1 -
IV.
The undersigned is entitled to receive the following proceeds:
V.
The property devolves to others pursuant to the provisions of applicable 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 to the proceeds of the deceased as described in
paragraph IV:
______________________________
______________________________
______________________________
VI.
Pursuant to applicable law of the State of California, 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.
VII.
Renunciation and Disclaimer of Property - 2 -
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
Type or Print Name
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 ______ .
Renunciation and Disclaimer of Property - 3 -
Signature
Type or Print Name
Address
City, State, Zip Code
Telephone
Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this
______ day of ____________ , 20 ______ .
Signature
Type or Print Name
Personal Representative/Executor/Executrix
Renunciation and Disclaimer of Property - 4 -
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