Fill and Sign the Maine Intestate Form

Renunciation and Disclaimer of Propert y Page 1 of 3 STATE OF MAINE COUNTY PROBATE COURT DOCKET In Re the Estate of: (Deceased) RENUNCIAITON AND DISCLAIMER OF PROPERTY (Intestate Succession) I. Pursuant to the Maine Statutes, Part 10, Art. II, the undersigned, , chooses to exercise his 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 t hat 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 Maine, and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounce s 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. Renunciation and Disclaimer of Propert y Page 2 of 3 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 exe cutrix of the decedent. DATE : Signature Type or Print Name STATE OF MAINE , COUNTY OF The foregoing instrument was acknowledged before me on (date) by (name of person acknowledged). Signature of Notary Public Print or Type Name of Notary Public Notary Public, State of Maine Date Commission Expires: I certify that on the , 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: Signature of Party Print or Type Name Street Address City, State and Zip Code Telephone Number Renunciation and Disclaimer of Propert y Page 3 of 3 Receipt of an executed copy of the above Renunciation and Disclaimer is ackn owledged this day of , 20 . Signature Type or Print Name Personal Representative/Executor/Executrix