Fill and Sign the Md Disclaimer Form

IN THE ORPHANS’ COURT FOR (or)       County , BEFORE THE REGISTER OF WILLS FOR MARYLAND RENUNCIATION AND DISCLAIMER OF PROPERTY (Nontestamentary Instrument or Contract) I. Pursuant to the Maryland Code, Article 9, the undersigned,       , chooses to exercise his right to disclaim an interest in property which has devolved to him as a result of a nontestamentary instrument or contract. A descrip tion of the instrument or contract is as follows:       II. The decedent died on       , 20       and the undersigned has an interest in the described property. III. Pursuant to the nontestamentary instrument or contract, the undersigned has an interest in the following property:       Renunciation and Disclaimer of Property Page 1 of 3 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 Maryland 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:       Signature       Type or Print Name STATE OF MARYLAND, COUNTY OF       Personally appeared before me, a Notary Public, in and for said county and state, on this       day of       , 20       , the within named Renunciation and Disclaimer of Property Page 2 of 3       , known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument and who acknowledges that he executed the same for the purposes therein contained. NOTARY PUBLIC       Print Name My commission expires:       I certify that on       , 20       , I delivered a true copy of the Rnunciation 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:       , 20       . Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this       day of       , 20       . Signature       Type or Print Name P ersonal Representative/Executor/Executrix Renunciation and Disclaimer of Property Page 3 of 3