Fill and Sign the Connecticut Property 497300939 Form

RENUNCIATION AND STATE OF CONNECTICUT DISCLAIMER OF PROPERTY COURT OF PROBATE TO: COURT OF PROBATE, DISTRICT OF       DISTRICT NO. RECORDED: ESTATE OF ________________________________________________ , DECEASED FIDUCIARY(IES) [Name(s), address(es), and telephone number(s)                   POSITION OF TRUST RENUNCIATION AND DISCLAIMER OF PROPERTY I. Pursuant to the General Statutes of Connecticut, Title 45, Chap. 802g, the undersigned, ______________________________ , chooses to exercise his/her right to disclaim a partial interest or the entire interest in the described property. II. Pursuant to the provisions of paragraph __________________ of decedent's last will and testament dated ________________________ (the "Will"), ______________________________ is entitled to inherit: ______________________________ III. Pursuant to applicable law of the State of Connecticut, and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounces and disclaims any interest or right to inherit the property or asset of the deceased described in paragraph II. IV. The property devolves to others pursuant to the provisions of applicable State law as though the undersigned had predeceased the decedent. V. 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 ______ Signature       Type or Print Name State of Connecticut County of ____________ On this the ______ day of __________________ , 20 ______ , before me, ________________________ , personally appeared ________________________ , known to me (or satisfactorily proven) to be the person(s) whose name(s) ____________ ( is or 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. Date: __________________ (Seal) Notary Public My commission expires:       Type or Print Name 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 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