Fill and Sign the Pursuant to the Mississippi Code Title 89 Chapter 021 the Undersigned Form

IN THE CHANCERY COURT OF ___________ COUNTY STATE OF MISSISSIPPI IN THE MATTER OF THE ESTATE OF)____________________________________)NO. ____________DECEASED))) RENUNCIATION AND DISCLAIMER OF JOINT TENANT INTEREST (Entire Interest of Joint Tenant) I. Pursuant to the Mississippi Code, Title 89, Chapter 021, the undersigned ________________________, the surviving joint tenant with right of survivorship, chooses to exercise his/her right to disclaim any and all interests he/ she may have in any property or interest that is the subject of a joint tenancy devolving to him/her because of the death of the decedent. II. The undersigned, as the surviving joint tenant, has an interest in the property of ________________________ (the 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. As a joint tenant with right of survivorship, the undersigned has an interest in the following property: ____________________________________________________________ V. Pursuant to applicable law of the State of Mississippi, 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 NameState of MississippiCounty of __________________Personally appeared before me, the undersigned authority in and for said county and state, on this ______ day of __________________ , 20______ , within my jurisdiction, the within named ______________________________ , who acknowledged that he/she/they executed the above and foregoing instrument. 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 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 of Party Printed Name Address City, State, and Zip Telephone NumberReceipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ______ day of __________________, 20______.Name Type or Print NamePersonal Representative/Executor/Executrix