Fill and Sign the Disclaimer of Inheritance Form

1 23456789 10111213141516171819202122232425 262728 ( Name, Address of Party or attorney) _____________________________ _____________________________ _____________________________ State Bar No: __________________ (____) _____ - _________________ Attorney for _______ (Or "In Pro Per" or "Pro Se") ______________ COURT OF THE STATE OF __________________ ___________________ JUDICIAL DISTRICT COUNTY OF ________________ IN RE: ESTATES OF ___________ ) CASE NO.: __________________ __________________________, ) DECEASED ) RENUNCIATION AND DISCLAIMER OF RIGHT TO INHERIT ____________________________________________________________________________ I. The undersigned ____________________ has an interest in the property in the above- captioned estate. ____________________ (decedent) died _____________________________. 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 ____________, 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. 1 23456789 10111213141516171819202122232425 262728 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_______. _________________________(Name) STATE OF ______________ ) : ss. County of __________________ ) SWORN TO, subscribed and acknowledged before me on ___________________________, 20_______ by _________________________________. _____________________________________ Notary Public or Deputy Court Clerk My Commission Expires: ____________________ Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this _________ day of __________________, 20_______. _______________________________ (Name)________________ Personal Representative/Executor/Executrix