Fill and Sign the Md Succession Form

-1- _________________ ___ JUDICIAL DISTRICT COURT FOR _____ ________ COUNTY CASE NO. ___________________ In Re the Estate of: Name of the Deceased RENUNCIATION AND DISCLAIMER ) OF PROPERTY (Intestate Succession) ) ) ) ) ) ) ) ) ) ) I. Pursuant to the Maryland Code, Article 9, 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 interes t in the described property. III. Pursuant to intestate succession, the undersigned has an interest in the following property: IV. -2- The undersigned attests that the disclaimer of the property interest will be filed no l ater 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 this day of , 20 . (Name) -3- 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 , known to me, or satisfactori ly proven, to be the person whose name is subscribed to the within instrument and who acknowledges that he/she/they (strike one) executed the same for the purposes therein contained. ______________________________ NOTARY PUBLIC Print Name: My Commission Expires: I certify that on the day of , 20 , I delivered a true copy of t he Renunciation and Disclaimer of Property by personal delivery, registered mail, and/ executrix, or other fiduciary of the decedent. DATED this the day of , 20 . _________________________________ Signature Print Name Address City, State, Zip Code Telephone -4- Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledge d this day of , 20 . (Name)________________ Personal Representative/Executor/Executrix