Fill and Sign the Disclaimer Form Sample

-1- IN THE ____________ COURT OF ____________ COUNTY, ALABAMA ________________ DIVISION IN RE: THE ESTATE OF _________________________ , ) THE DECEASED ) ) ) ) ) Case No. __________________ ) RENUNCIATION AND DISCLAIMER ) PROPERTY ) ) ) I. Pursuant to the Alabama Code, Title 43, Chap. 8, Article 11, 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 th e 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: ________________________ -2- V. Pursuant to applicable law of the State of Alabama, and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounces and disclaims any interest or right to the prop erty 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 exec utrix of the Estate of ________________________ to be filed with the court in the above -captioned proceeding. DATED this ______ day of ____________ , 20 ______ . _________________________ (Name) -3- THE STATE OF ALABAMA ____________ COUNTY I, a Notary Public, hereby certify that ____________ whose name is signed to the foregoing instrument or conveyance, and who is known to me, acknowledged before me on this day that , being informed of the contents of the conveyance, he/she/they executed the same voluntarily on the day the same bears date. Given under my hand this ______ day of ____________ , A. D. 20 ______ . ____________ Notary Public Print Name ____________ My commission expires: ____________ __________________ 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 -4- Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ______ day of _________ _________ , 20 ______ . _______________________________ (Name)________________ Personal Representative/Executor/Executrix