Fill and Sign the Renunciation Form

- 1 - Prepared by U.S. Legal Forms, Inc. Copyright 2016 - U.S. Legal Forms, Inc. STATE OF NEW YORK Renunciation And Disclaimer of Joint Tenant Interest (Intestate Succession) Control Number – NY - 06 - 03 - 2 - 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 t hen 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. - 3 - DISCLAIMER These materials were developed by U.S. Legal Forms, Inc. based upon statutes and forms for the State of New York. All Information and Forms are subject to this Disclaimer: All forms in this package are provided without any warranty, express or implied, as to their legal effect and completeness. Please use at your own risk. If you have a serious legal problem we suggest that you consult an attorney. U.S. Legal Forms, Inc. does not provide legal advice. The products offered by U.S. Legal Forms (USLF) are not a substitute for the advice of an attorney. THESE MATERIALS ARE PROVIDED "AS IS" WITHOUT ANY EXPRESS OR IMPLIED WARRANTY OF ANY KIND INCLUDING WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT OF INTELLECTUAL PROPERTY, OR FITNESS FOR ANY PARTICULAR PURPOSE. IN NO EVENT SHALL U. S. LEGAL FORMS, INC. OR ITS AGENTS OR OFFICERS BE LIABLE FOR ANY DAMAGES WHATSOEVER (INCLUDING, WITHOUT LIMITATION DAMAGES FOR LOSS OF PROFITS, BUSINESS INTERRUPTION, LOSS OF INFORMATION) ARISING OUT OF THE USE OF OR INABILITY TO USE THE MATERIALS, EVEN IF U.S. LEGAL FORMS, INC. HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Renunciation and Disclaimer of Property1 SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTY OF --------------------------------------------------------------------------- Estate of RENUNCIATION AND DISCLAIMER OF PROPERTY (TESTATE) Deceased. File No. --------------------------------------------------------------------------- I. Pursuant to the New York State Consolidated Laws, Chapter 17-B, Article 2, Part 1, 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 intestate 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 intestate succession, the undersigned is entitled to receive the following property: ________________________________________________________________________ V. Pursuant to applicable law of New York State, 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. Renunciation and Disclaimer of Property2 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 STATE OF NEW YORK COUNTY OF __________________ On the ______ day of __________________ in the year 20______ before me, the undersigned, personally appeared ______________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity (ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. Notary Public My commission expires: Type or Print Name Renunciation and Disclaimer of Property3 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 Affidavit in Relation to Renunciation and Disclaimer of PropertyPage 1 of 1 SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTY OF --------------------------------------------------------------------------- Estate of AFFIDAVIT IN RELATION TO RENUNCIATION AND DISCLAIMER OF PROPERTY , (Life Insurance or Annuity Contract) Deceased. File No. --------------------------------------------------------------------------- STATE OF NEW YORK ) ) ss.: COUNTY OF ) I, , being duly sworn, depose and say: (1) My domicile is (Street Address) (City/Town/Village) (County) (State) (Zip) (Telephone Number) My mailing address is (If different from domicile) (2) Pursuant to § 2-1.11(b)(2), I hereby affirmatively state that I have not received and I am not to receive any consideration in money or money’s worth for the attached Renunciation from a person or persons whose interest is to be accelerated, unless payment has been authorized by the Court. Signature of Affiant Print Name Sworn to before me on __________________, 20______ Notary Public