Fill and Sign the Hawaii Disclaimer Form

RENUNCIAT ION AND DISCLAIMER OF PROPERTY (Real Property Interest) I. Pursuant to the Hawaii Revised Statutes, Chap. 526, the undersigned, _______________ _______________ chooses to exercise his/her right to disclaim an interest in the real property which has devolved to him/her because of the death of the decedent. II. The decedent died on ______________________________ ______ , 20 _____ and the undersigned has an interest in the described real property. III. A description of the real property is as follows: _______________________________________________________________________________________ IV. The undersigned attests that the disclaimer o f the real property interest will be filed no later than nine months after the death of the decedent. V. Pursuant to applicable law of the State of Hawaii and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounces and disclaims any interest or right to the real of the deceased described in paragraph III. VI. The real property devolves to others pursuant to the provisions of applicable State law as though the undersigned had predeceased the decedent. VII. Thi s 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 executr ix of the decedent. A copy of the disclaimer shall be recorded in the office of the county clerk and recorder of the county in which the property or interest disclaimed is located. 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 HAWAII COUNTY OF ______________________ On this _______ day of _____________________ , 20 ___ , before me personally appeared ____________________________________ , to me known to be the person (or persons) described in and who executed the foregoing instrument, and ackn owledged that he/she/they executed the same as his/her/their free act and deed. ______________________________ Notary Public Print Name: __________________________ My Commission Expires: _____________________ I certif y that on __________________ ____ , 20 ___ , I delivered a true copy of the Renunciation and Disclaimer of Property by ( ) personal delivery, ( ) registered mail, a nd/or ( ) certified mail, return receipt requested, to the personal representative/executor/executrix or other fiduciary of the decedent. DATED this the ______ day of __________________ , 20 ______ . _________________________________ Signature ____________________________________ Print Name ____________________________________ Address ____________________________________ City, State, Zip Code ____________________________________ Telephone