Fill and Sign the Hi Property Form

RENUNCIATION AND DISCLAIMER OF PROPERTY (Intestate Succession) I. Pursuant to the Hawaii Revised Statutes, Chap. 526, 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 intestate 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 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 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 executrix 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 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 acknowledged that he/she/they executed the same as his/her/their free act and deed. ______________________________ Notary Public Print Name: ______________________________ 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