(Name, Address of Party or Attorney)

_____________________________

_____________________________

_____________________________

State Bar No: __________________ 

Telephone No: ____________________  

Attorney for __________________ (Or “In Pro Per” or “Pro Se”)

 ______________ COURT OF THE STATE OF ______________ 

 ______________ JUDICIAL DISTRICT

COUNTY OF _________________

IN RE: ESTATES OF ______________ )           CASE NO.: ________

______________________________ )

DECEASED                                       RENUNCIATION AND DISCLAIMER

                                    OF RIGHT TO INHERIT

____________________________________________________________________________

I.

The undersigned ________________________ has an interest in the property in the above- captioned estate.

_________________ (decedent) died ________________.

II.

Pursuant to the provisions of paragraph ________________ of decedent’s last will and testament dated __________________ (the “Will”), is entitled to inherit ________________________________________________

III.

Pursuant to applicable law of the State of _____________ , and the Internal Revenue Code of 1986, if applicable, the undersigned hereby renounces and disclaims any interest or right to inherit the property or asset of the deceased described in paragraph I.

IV.

The property devolves to others pursuant to the provisions of applicable State law as though the undersigned had predeceased the decedent.

V.

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___ .

_________________________

                                        (Name)

STATE OF _______________________

COUNTY OF _____________________

SWORN TO, subscribed and acknowledged before me on _______________ , 20____  by__________________________ .

_____________________________________

Notary Public or Deputy Court Clerk

My Commission Expires:

______________________

Receipt of an executed copy of the above Renunciation and Disclaimer is acknowledged this ___ day of ________, 20___ .

_______________________________

(Name)

Personal Representative/Executor/Executrix

State Specific Real Estate Forms

–For State Specific Real Estate Forms you can download in Word format, go to http://www.uslegalforms.com/realestate/