Disclaimer / Renunciation of Interest (Qualified Disclaimer) — Connecticut

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

State of Connecticut

1. DISCLAIMANT AND INTEREST

I, [FULL LEGAL NAME], of [STREET ADDRESS, CITY, STATE, ZIP], irrevocably disclaim the interest identified below. My date of birth is [__/__/____].

Source of interest (select one and identify the governing instrument or estate):

☐ A will or intestate estate under Conn. Gen. Stat. § 45a-579. Decedent: [NAME]; date of death: [__/__/____]; estate/probate number, if any: [NUMBER].

☐ A nontestamentary instrument under Conn. Gen. Stat. § 45a-583, including a non-testamentary trust, insurance policy, annuity, beneficiary designation, account, or survivorship interest. Instrument and date: [DESCRIPTION AND DATE]; transferor: [NAME]; effective date of instrument for § 45a-583(d): [__/__/____].

Interest and property disclaimed: [DESCRIBE EXACT INTEREST, ASSET, ACCOUNT OR POLICY, AND GOVERNING PROVISION; ATTACH EXHIBIT A FOR REAL PROPERTY].

Extent (select one):

☐ The entire identified interest.

☐ Only this specified part of the identified interest: [FRACTION, PERCENTAGE, PECUNIARY AMOUNT, OR SEPARATE PROPERTY]. I have identified the part with enough precision to show its extent. Do not select a partial disclaimer of a real-property joint-tenancy interest after another joint tenant's death; § 45a-583(f) makes it void.

2. DISCLAIMER

I refuse to accept the interest identified in Section 1 to the extent selected there. I make this disclaimer irrevocably and without qualification, consideration, or direction as to who receives the disclaimed interest. I have not accepted the disclaimed interest or its benefits or assigned, conveyed, encumbered, pledged, or transferred it, and I have not waived my right to disclaim it in writing. I understand that other acts, including a judicial sale or failure to redeem after strict foreclosure, may bar a disclaimer under Conn. Gen. Stat. § 45a-580(a).

The interest shall pass under the governing will, nontestamentary instrument, and applicable law, without my direction. I make no designation of a successor recipient in this document.

3. TIMING AND DELIVERY RECORD

Connecticut deadline used (select and complete the applicable route):

☐ Present interest under a will or intestacy: nine months after the later of the decedent's or donee's death and, for a natural person, attainment of age 18. Conn. Gen. Stat. § 45a-579(d)(1). Deadline: [__/__/____].

☐ Future interest under a will or intestacy: nine months after the later of final ascertainment and indefeasible vesting and, for a natural person, attainment of age 18. Conn. Gen. Stat. § 45a-579(d)(2). Vesting event/date: [DESCRIPTION; __/__/____]. Deadline: [__/__/____].

☐ Present interest under a nontestamentary instrument: nine months after the later of the instrument's effective date as defined by § 45a-583(d) and, for a natural person, attainment of age 18. Conn. Gen. Stat. § 45a-583(d)(1). Deadline: [__/__/____].

☐ Future interest under a nontestamentary instrument: nine months after the later of final ascertainment and indefeasible vesting and, for a natural person, attainment of age 18. Conn. Gen. Stat. § 45a-583(d)(2). Vesting event/date: [DESCRIPTION; __/__/____]. Deadline: [__/__/____].

☐ Nontestamentary interest of which I had no actual knowledge: nine months after the later of first actual knowledge and, for a natural person, attainment of age 18. Conn. Gen. Stat. § 45a-583(d)(3). First actual knowledge: [__/__/____]. Deadline: [__/__/____].

Federal qualified-disclaimer deadline: Under 26 U.S.C. § 2518(b)(2) and 26 C.F.R. § 25.2518-2(c), the writing must be received within nine months after the later of the transfer creating this interest or my attainment of age 21, subject to the regulation's qualifying mailing and weekend/holiday rules. Transfer-creating event/date: [DESCRIPTION; __/__/____]. Federal deadline: [__/__/____]. Federal and Connecticut timing may differ.

Connecticut delivery: I will deliver the signed disclaimer within the applicable Connecticut period:

☐ For a § 45a-579 interest, to the legal representative of the estate of the decedent or deceased donee of the power, or the holder of legal title to the property. § 45a-579(d)(3).

☐ For a § 45a-583 interest, to the transferor, the transferor's legal representative, or the holder of legal title to the property. § 45a-583(d)(4).

Recipient and capacity: [NAME AND CAPACITY]; address: [ADDRESS]. Date delivered: [__/__/____]; method: [METHOD]. For federal purposes, confirm receipt by a person listed in 26 U.S.C. § 2518(b)(2) and 26 C.F.R. § 25.2518-2(b)(2).

Real property: If the disclaimer concerns Connecticut real property, record a copy in the land records of the town where the property is situated. For a § 45a-579 interest, § 45a-579(d)(4) requires recording within its nine-month period and specifies the consequence of failing to record. For a § 45a-583 interest, § 45a-583(d)(5) governs effectiveness against others until recording. Town: [TOWN]; recording date and reference: [DATE / BOOK / PAGE OR INSTRUMENT NUMBER].

Optional probate evidence for § 45a-579 only: A copy of the disclaimer and a receipt executed by the legal representative or title holder in the manner required for the disclaimer may be filed within the nine-month period in the probate court having jurisdiction over the estate of the decedent or deceased donee. Section 45a-579(d) makes that filing conclusive evidence of timely disclaimer; it is not a condition to disclaimer.

4. SIGNATURE AND ACKNOWLEDGMENT

I execute this disclaimer in the manner provided for deeds of real property under Conn. Gen. Stat. §§ 45a-579(c) or 45a-583(c) and 47-5. I sign in the presence of two attesting witnesses and acknowledge this instrument as my free act and deed.

Date: [__/__/____] Place: [CITY, STATE]

Disclaimant signature: ____________________________________

Printed name: [FULL LEGAL NAME]

Witness 1 signature: ____________________________________ Printed name: [NAME]

Witness 2 signature: ____________________________________ Printed name: [NAME]

Acknowledgment

State of [STATE], County of [COUNTY]

On [__/__/____], [FULL LEGAL NAME] personally appeared before me, proved to me through satisfactory evidence of identification to be the person who signed this instrument, and acknowledged executing it as their free act and deed.

Signature of notary or other authorized officer: ____________________________________

Printed name and title: [NAME AND TITLE] Commission expiration: [__/__/____] Seal: [SEAL]

5. RECEIPT OF DELIVERY

I received this signed disclaimer on [__/__/____] at [TIME].

Recipient signature: ____________________________________

Printed name, capacity, and address: [NAME, CAPACITY, ADDRESS]

SOURCES AND REFERENCES

• Conn. Gen. Stat. ch. 802g, §§ 45a-578 to 45a-585: § 45a-579 covers interests under wills or intestacy; § 45a-580 lists bars and binding effect; § 45a-583 covers nontestamentary instruments, including its separate delivery, recording, and joint-tenancy rules.
• Conn. Gen. Stat. § 47-5: a Connecticut conveyance is written, subscribed, acknowledged, and attested by two witnesses.
• 26 U.S.C. § 2518 and 26 C.F.R. §§ 25.2518-2, 25.2518-3: federal conditions, including receipt, nonacceptance, passage without direction, and limits on qualified partial disclaimers.