Fill and Sign the Pennsylvania Renunciation Form

Prepared by U.S. Legal Forms, Inc. Copyright 2016 - U.S. Legal Forms, Inc. STATE OF PENNSYLVANIA RENUNCIATION AND DISCLAIMER OF PROPERTY [TESTATE] CONTROL NUMBER – PA - 06 - 03 - 1 - NOTE ABOUT COMPLETING THE FORMS The forms in this packet contain “form fields” created using Microsoft Word. “Form fields” facilitate completion of the forms using your computer. They do not limit you ability to print the form “in blank” and complete with a typewriter or by hand. If you do not see the gray shaded form fields, go the View menu, click on Toolbars, and then select Forms. This will open the forms toolbar. Look for the button on the forms toolbar that resembles a shaded letter “a”. Click in this button and the form fields will be visible. The forms are locked which means that the content of the forms cannot be changed. You can only fill in the information in the fields. If you need to make any changes in the body of the form, it is necessary for you “unlock” or “unprotect” the form. IF YOU INTEND TO MAKE CHANGES TO THE CONTENT, DO SO BEFORE YOU BEGIN TO FILL IN THE FIELDS. IF YOU UNLOCK THE DOCUMENT AFTER YOU HAVE BEGUN TO COMPLETE THE FIELDS, WHEN YOU RELOCK, ALL INFORMATION YOU ENTERED WILL BE LOST. To unlock click on “Tools” in the Menu bar and then selecting “unprotect document”. You may then be prompted to enter a password. If so, the password is “uslf”. That is uslf in lower case letters without the quotation marks . After you make the changes relock the document before you being to complete the fields. After any required changes and re-protecting the document, click on the first form field and enter the required information. You will be able to navigate through the document from form field to form field using your tab key. Tab to a form field and insert your data. If problems, please let us know. DISCLAIMER These materials were developed by U.S. Legal Forms, Inc. based upon statutes and forms for the State of Pennsylvania. 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HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. - 2 - RENUNCIATION AND DISCLAIMER OF PROPERTY Estate of ________________________ No. __________________ also known as ________________________ To: __________________ __________________ , Deceased . Register of Wills for the County of Social Security No. __________________ ____________ in the Commonwealth of Pennsylvania I. Pursuant to the Pennsylvania Statutes, Title 20, Chapter 62, 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: ________________________________________________________________________ - 1 - V. Pursuant to applicable law of the State of Pennsylvania, 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 Name ) Commonwealth of Pennsylvania County of __________________ On this ______ day of __________________ , ____________ , before me a notary public in and for the Commonwealth of Pennsylvania, the undersigned officer, personally appeared ____________________________________ , known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained. - 2 - In witness whereof, I hereunto set my hand and official seal. Notary Public My commission expires:       Type or Print Name I certify that on the ______ day of ____________ , 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 this the ______ day of ____________ , 20 ______ .       Signature of Party       Printed Name       Address       City, State, and Zip       Telephone Number Receipt 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 - 3 -