Fill and Sign the Delaware Disclaimer Form

RENUNCIATION AND DISCLAIMER OF PROPERTY (Intestate Succession) I. Pursuant to the Delaware Code, Title 12, Chapter 6, the undersigned, __________________ chooses to exercise his/her right to disclaim ( ) a partial interest or ( ) the entire interest in the described property. II. The decedent died intestat e on __________________ ____ , 20 ____ and the undersigned has an interest in the described property. III. Pursuant to intestate succession, the undersigned has an interest in the following property: ______________________________________________________________________________ IV. The undersigned attests that the disclaimer of the property interest will be filed no later than nine months after the d eath of the decedent. V. Pursuant to applicable law of the State of Delaware, 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 III. 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 exe cutrix of the decedent. DATED this _______ day of __________________ , 20 ____ . _________________________ (Name) Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ______ day of __________________ , 20 ____ . _______________________________ (Name) __________________ Personal Representative/Executor/Executrix State of Delaw are County of __________________ __________________ (date) _______________________________________________________ (name(s) of person(s)). This instrument was acknowledged before me on _______________ , 20 ___ by __________________________ . ________________________________ Notary Public Print Name: __________________ (Seal, if any) My commission expires: ____________________ I certify that on __________________ ____ , 20 _____ , I delivered a true copy of the Renunciation and Disclaimer of Property by ( ) personal delivery, ( ) registered mail, and/or ( ) certified mail, return receipt requested, to the personal representative/executor/executrix or other fiduciary of the decedent. DATED this ____ day of __________________ , 20 ___ . _________________________________ Signature _______________________________ Print Name _______________________________ Address _______________________________ City, State, Zip Code _______________________________ Telephone