Fill and Sign the Renunciation and Disclaimer of Form

Name of Person Filing: Your Address: Your City, State, Zip Code: Your Telephone Number: ATLAS Number (if applicable): Attorney Bar Number (if applicable): Representing Self, Without a Lawyer or Petitioner or Respondent IN THE SUPERIOR COURT OF THE STATE OF ARIZONA In and for the County of __________________ IN THE MATTER OF THE ESTATE OF :CASE NO. __________________DeceasedRENUNCIATION AND DISCLAIMER OFJOINT TENANT INTEREST(Entire Interest of Joint Tenant) ____________________________________________________________________________ I. Pursuant to the Arizona Revised Statutes, Title 14, Article 8, 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 Arizona, 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 decedent.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 Print or Type Name Personal Representative/Executor/Executrix State of ArizonaCounty of __________________ The foregoing instrument was acknowledged before me this ______ day of __________________, 20______, by ____________________________________ (person). 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 Number