Fill and Sign the Court System Information Alaska Court System State of

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT _________________________________IN RE: THE ESTATE OF)______________________________))))Case No: ____________) _____________________)RENUNCIATION AND DISCLAIMER) OF PROPERTY))) I.Pursuant to the Alaska Statutes, Title 13, Chap. 13.12, Section 13.12.801, the undersigned, ______________________________, chooses to exercise his/her right to disclaim ( ) a partial interest or ( ) the entire interest in the described property. II. The undersigned has an interest in the property in the above-captioned estate of ______________________________ (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. IV. Pursuant to the provisions of paragraph ____________ of decedent's last will and testament dated __________________ (the "Will"), ______________________________ is entitled to receive the following property: ________________________________________________. V. Pursuant to applicable law of the State of Alaska, 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. VI. The property devolves 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______.Signature Type or Print Name State of Alaska____________ Judicial DistrictThe foregoing instrument was acknowledged before me this ______ day of __________________ , 20______ by ______________________________ (signing party) __________________ (marital status).Given under my hand this the ______ day of __________________ , 20______Notary PublicMy commission expires: Type or Print NameI 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 NamePersonal Representative/Executor/Executrix