Fill and Sign the Of Property Interest Form

IN THE ____________ COURT OF __________________ , ARKANSAS __________________ DISTRICT IN RE ESTATE OF Case No.________________________________________________NAME OF THE DECEASED RENUNCIATION AND DISCLAIMER OF PROPERTY INTEREST I. Pursuant to the Arkansas Code Title 28, Subtitle 1, Chap. 2, the undersigned, ______________________________, chooses to exercise his/her right to disclaim ( ) a partial interest or () the entire interest in the described property. II. The undersigned has an interest in the property in the above-captioned estate of ______________________________ (decedent) who died on __________________. III. The undersigned attests that the disclaimer of the property interest will be filed no later than nine months after the death of the decedent. IV. Pursuant to the provisions of paragraph ______ of decedent's last will and testament dated __________________ (the "Will"), ______________________________ is entitled to receive the following property: ____________________________________________________________ V. Pursuant to applicable law of the State of Arkansas, 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. 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 Estate of ______________________________ to be filed with the court in the above-captioned proceeding.DATED this ______ day of __________________, 20______.Signature Type or Print NameReceipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ______ day of __________________, 20______.Signature Type or Print Name Personal Representative/Executor/Executrix STATE OF ARKANSASCOUNTY OF _____________________________ On this the ______ day of __________________, 20______, before me, ______________________________, the undersigned officer, personally appeared ______________________________, known to me (or satisfactorily proven) to be the person whose name is/are subscribed to the within instrument and acknowledged that he/she/they executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Notary PublicMy commission expires: Type or Print Name I certify that on __________________, 20______, I delivered a true copy of the Renunciation and Disclaimer of Property Interest by ( ) personal delivery, () registered mail, and/or () certified mail 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