Fill and Sign the Disclaimer Property Sample Form

Renunciation and Disclaimer of Property Page 1 of 3 (Name, Address of Party or attorney) State Bar No: ( ) - __________________ Attorney for (Or "In Pro Per" or "Pro Se") IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, ____________ COUNTY, ILLINOIS Estate of ) ) No. Deceased. ) RENUNCIATION AND DISCLAIMER OF PROPERTY I. Pursuant to the Illinois Compiled Statutes, Chapter 75, Article 2, 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. Pursuant to the provisions of paragraph of decedent's last will and testament dated (the "Will"), is entitled to receive th e following property: Renunciation and Disclaimer of Property Page 2 of 3 IV Pursuant to applicable law of the St ate of Illinois, 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. V. The property devolves to others pursuant to the provisions of applicable State law as though the undersigned had predeceased the decedent. VI. 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 of Party Printed Name Renunciation and Disclaimer of Property Page 3 of 3 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 STATE OF ILLINOIS COUNTY OF ________________ The foregoing instrument was acknowledged before me this day of 20 by [name of person acknowledged] . (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 del ivery, 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