Disclaimer / Renunciation of Interest (Qualified Disclaimer) — California

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

State of California — Cal. Prob. Code §§ 260–295

1. DISCLAIMANT INFORMATION

2. IDENTIFICATION OF THE TRANSFER AND INTEREST DISCLAIMED

I, the Disclaimant named above, identify the interest I am disclaiming as follows.

Source of the interest (the "creator of the interest" under Cal. Prob. Code § 278(a)):

☐ Will / Last Will and Testament of the Decedent
☐ Intestate succession (Cal. Prob. Code § 6400 et seq.)
☐ Revocable (living) trust or testamentary trust
☐ Beneficiary designation — ☐ life insurance / ☐ annuity / ☐ retirement account (IRA, 401(k), etc.) / ☐ POD / TOD account or security
☐ Surviving joint tenant (right of survivorship)
☐ Power of appointment (testamentary or presently exercisable)
☐ Other: [________________________________]

Description of the specific property or portion disclaimed:

[DESCRIBE THE PROPERTY — e.g., "an undivided one-half (1/2) interest in the real property commonly known as [ADDRESS], [COUNTY] County, California, APN [____], legally described in Exhibit A"; or "the sum of $[________]"; or "all shares of [____]"; or "the entire residuary bequest under Article [___] of the Will."]

3. STATUTORY AUTHORITY

This Disclaimer is made under:

• Cal. Prob. Code § 275 — "A beneficiary may disclaim any interest, in whole or in part, by filing a disclaimer as provided in this part."
• Cal. Prob. Code § 278 — contents requirements (writing; signed; identify creator; describe interest; state the disclaimer and its extent).
• Cal. Prob. Code § 279 — time for filing and the nine-month conclusive presumption of reasonableness.
• Cal. Prob. Code § 280 — filing of the disclaimer, and recording where the disclaimer affects real property.
• Cal. Prob. Code § 282 — effect of disclaimer (interest passes as if the disclaimant predeceased the creator; the disclaimer relates back for all purposes).
• 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2 — federal qualified-disclaimer requirements.

4. THE DISCLAIMER

The Disclaimant hereby irrevocably and unqualifiedly disclaims, renounces, and refuses to accept all right, title, and interest in and to the property described in Section 2, to the extent indicated below:

☐ FULL DISCLAIMER — The Disclaimant disclaims the entire interest described in Section 2.

☐ PARTIAL DISCLAIMER — The Disclaimant disclaims only the following part of the interest described in Section 2 (express as a fraction, percentage, pecuniary amount, or specific asset):
[________________________________________________________]

The extent of this disclaimer is stated above as required by Cal. Prob. Code § 278(c). The Disclaimant makes this Disclaimer freely and voluntarily, for no consideration, and not at the direction of any other person.

5. QUALIFIED-DISCLAIMER REPRESENTATIONS (IRC § 2518)

The Disclaimant represents and certifies that:

☐ This Disclaimer is in writing and signed by the Disclaimant (Cal. Prob. Code § 278; Treas. Reg. § 25.2518-2(b)).
☐ This Disclaimer is being delivered and filed within nine (9) months after the later of (a) the death of the creator / date of the transfer creating the interest or (b) the date the Disclaimant attained age 21 (Cal. Prob. Code § 279; 26 U.S.C. § 2518(b)(2)).
☐ The Disclaimant has NOT accepted the disclaimed interest or any of its benefits (including any income, dividends, distributions, or use of the property) (26 U.S.C. § 2518(b)(3); Treas. Reg. § 25.2518-2(d)).
☐ As a result of this Disclaimer, the interest passes without any direction on the part of the Disclaimant (26 U.S.C. § 2518(b)(4)).
☐ The disclaimed interest passes as if the Disclaimant had predeceased the creator of the interest (Cal. Prob. Code § 282(a)).
☐ This Disclaimer is irrevocable (Cal. Prob. Code § 281).

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under Cal. Prob. Code § 282(a), unless the creator of the interest has provided for a specific disposition in the event of a disclaimer, the disclaimed interest shall descend, go, be distributed, or continue to be held:

• as to a present interest, as if the Disclaimant had predeceased the creator of the interest; or
• as to a future interest, as if the Disclaimant had died before the event determining that the taker of the interest became finally ascertained and the taker's interest indefeasibly vested.

The Disclaimer relates back for all purposes to the date of death of the creator of the disclaimed interest (or the determinative event), as provided in Cal. Prob. Code § 282(a). The Disclaimant understands and acknowledges that the Disclaimant has no power to direct who receives the disclaimed interest.

To the Disclaimant's knowledge, the disclaimed interest will pass to: [NAME(S) OF SUCCESSOR TAKER(S), if known — for information only].

7. IRREVOCABILITY AND BINDING EFFECT

This Disclaimer is irrevocable and binding upon the Disclaimant and upon the Disclaimant's heirs, successors, assigns, agents, and personal representatives. The Disclaimant has not assigned, transferred, encumbered, pledged, or otherwise disposed of the disclaimed interest, and has done no act that would constitute acceptance of the interest under Cal. Prob. Code § 285 or Treas. Reg. § 25.2518-2(d).

8. DELIVERY, FILING, AND RECORDING

In accordance with Cal. Prob. Code § 280(a), the Disclaimant will file and/or deliver this Disclaimer to one or more of the following (check all that apply):

☐ The Superior Court of California, County of [COUNTY] — the county in which the Decedent's estate is administered (or, if there is no administration, the county where administration would be proper).
☐ The trustee, personal representative, other fiduciary, or person responsible for distributing the interest to the beneficiary.
☐ Any other person having custody, possession, or legal title to the interest (e.g., insurer, plan administrator, financial institution).
☐ The creator of the interest (e.g., the transferor under a beneficiary designation, where applicable).

Real property — recording (Cal. Prob. Code § 280(b)): ☐ If this Disclaimer affects real property or an obligation secured by real property, and is acknowledged and proved in like manner as a grant of real property, it will be recorded in the Office of the County Recorder of [COUNTY] County, California, with like effect as a grant of real property.

9. SIGNATURE AND ACKNOWLEDGMENT

Executed on [__/__/____], at [CITY], California.

Disclaimant Signature: ______________________________________

Printed Name: [____________________________________]

Notary Acknowledgment

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California, County of [____________________]

On [__/__/____], before me, [NOTARY NAME], Notary Public, personally appeared [DISCLAIMANT NAME], who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature on the instrument the person executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Notary Signature: ______________________________________ [NOTARY SEAL]

My commission expires: [__/__/____]

10. VERIFICATION / DECLARATION

I, [DISCLAIMANT NAME], declare under penalty of perjury under the laws of the State of California that the foregoing Disclaimer is true and correct, that I have not accepted the disclaimed interest or any of its benefits, and that I execute this Disclaimer freely and voluntarily.

Executed on [__/__/____] at [CITY], California.

Signature: ______________________________________

11. CERTIFICATE OF DELIVERY / SERVICE

I certify that on [__/__/____] a true and correct copy of this Disclaimer was delivered or filed as follows:

Signature: ______________________________________
Printed Name: [DISCLAIMANT / ATTORNEY NAME]
California State Bar No. (if attorney): [____________]

12. ATTACHMENTS CHECKLIST

☐ Copy of the Will / Codicil (if interest arises under a will)
☐ Copy of the Trust instrument (if interest arises under a trust)
☐ Copy of the beneficiary designation (life insurance / retirement / POD / TOD)
☐ Legal description of real property (Exhibit A) — if real property is disclaimed
☐ Certified copy of the Decedent's Death Certificate
☐ Proof of delivery / filing (certified-mail receipt, court e-file confirmation, or signed receipt)
☐ Recorded copy from the County Recorder (if real property disclaimer was recorded under § 280(b))

SOURCES AND REFERENCES

• Cal. Prob. Code §§ 275, 278, 279, 280, 281, 282, 285 — California Legislative Information: https://leginfo.legislature.ca.gov
• 26 U.S.C. § 2518 (qualified disclaimers); Treas. Reg. § 25.2518-2 (requirements).