Fill and Sign the Washington Disclaimer Form

RENUNCIATION AND DISCLAIMER OF PROPERTY (Community Property Interest) I. Pursuant to the Revised Code of Washington, Title 11, Chapter 11.86, the undersigned,       chooses to exercise his/her right to disclaim an interest in the community property which has devolved to him/her because of the death of the decedent. II. The decedent died on             , 20       and the undersigned has an interest in the described community property. III. A description of the community property is as follows:       IV. The undersigned attests that the disclaimer of the community property interest will be filed no later than nine months after the death of the decedent. V. Pursuant to applicable law of the State of Washington and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounces and disclaims any interest or right to the real of the deceased described in paragraph III. VI. The real property devolves to others pursuant to the provisions of applicable State law as though the undersigned had predeceased the decedent. - 1 - 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. A copy of the disclaimer shall be recorded in the office of the county clerk and recorder of the county in which the community property or interest disclaimed is located. DATED this       day of       , 20       . _________________________ (Name) - 2 - STATE OF WASHINGTON COUNTY OF       On this day personally appeared before me       , to me known to be the individual(s) described in and who executed the within and foregoing instrument, and acknowledged that he/she/they signed the same as his/her/their free and voluntary act and deed, for the uses and purposes therein mentioned. Given under my hand and seal of office this       day of       , 20______.       Notary Public residing at       ______________________________ Printed Name:       My Commission Expires:       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       Print Name       Address       City, State, Zip Code       - 3 - Telephone - 4 - Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this       day of       , 20       .       (Name)       Personal Representative/Executor/Executrix - 5 -