Fill and Sign the Joint Tenant Tenancy 481374804 Form

-1- RENUNCIATION AND DISCLAIMER OF JOINT TENANT INTEREST (Entire Interest of Joint Tenant) I. Pursuant to the West Virginia Code, Chapter 42, Article 6, the undersigned, _______________, the surviving joint tenant with right of survivorship, chooses to exercise his/her right to disclaim any and all interests he/ she may have in any property or interest that is the subject of a joint tenancy devolving to him/her because of the death of the decedent. II. The undersigned, as the surviving joint tenant, has an interest in the property of __________________ (the decedent) who died on __________________. III. The undersigned attests that the disclaimer of the property interest will be filed no later than six months after the death of the decedent. IV. As a joint tenant with right of survivorship, the undersigned has an interest in the following property: ____________________________________________________________ V. Pursuant to applicable law of the State of Wyoming, 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 IV. -2- 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 the ______ day of ____________, 20______. ___________________________________ (Name) -3- STATE OF WEST VIRGINIACOUNTY OF __________________This instrument was acknowledged before me on ______ (date) by __________________ (name or names of person or persons acknowledging).(Seal)Notary PublicMy commission expires: Type or Print NameI 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______.Signature Type or Print NamePersonal Representative/Executor/Executrix