Fill and Sign the North Dakota Disclaimer Form

RENUNCIATION AND DISCLAIMER OF PROPERTY (Intestate Succession) I. Pursuant to the North Dakota Century Code, Chapter 30.1, 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 North Dakota, 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 NORTH DAKOTA COUNTY OF _____________________ On this ________ day of __________________ , in the year __________, before me personally appeared _________________________, known to me (or proved to me on the oath of ___________________________) to be the person who is described in and who executed the within and foregoing instrument, and acknowledged to me that ________________________________________________ (he/she/they) executed the same. (Seal) _____________________________ Notary Public Printed Name: _________________ 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