Disclaimer / Renunciation of Interest (Qualified Disclaimer) — Connecticut

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

State of Connecticut — Chapter 802g, Conn. Gen. Stat. §§ 45a-578 to 45a-585

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:

☐ Will / Last Will and Testament of the Decedent (§ 45a-579)
☐ Intestate succession (§ 45a-579)
☐ Nontestamentary instrument — trust (other than a testamentary trust), annuity, life/health/accident insurance policy, bank account, or other contract naming a beneficiary (§ 45a-580; see § 45a-578(b)(1))
☐ Beneficiary designation — ☐ life insurance / ☐ annuity / ☐ retirement account / ☐ POD / TOD account
☐ Surviving joint tenant (right of survivorship; § 45a-578(b)(4))
☐ Power of appointment (donee or appointee)
☐ 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 known as [ADDRESS], Town of [TOWN], Connecticut, more particularly described in Exhibit A"; or "the sum of $[________]"; or "the entire residuary bequest under Article [___] of the Will."]

3. STATUTORY AUTHORITY

This Disclaimer is made under Chapter 802g of the Connecticut General Statutes:

• Conn. Gen. Stat. § 45a-578 — the chapter "shall be liberally construed to promote ... readily permitting the disclaimer of interests"; defines "interest," "nontestamentary instrument," and "will"; a complying disclaimer is irrevocable.
• Conn. Gen. Stat. § 45a-579(a) — an heir, next of kin, devisee, legatee, beneficiary under a will, trustee, donee/appointee under a power of appointment, or any other recipient of an interest may disclaim, in whole or in part, any interest under a will or passing by intestacy.
• Conn. Gen. Stat. § 45a-579(c) — the disclaimer shall (1) describe the interest disclaimed, (2) be executed in the manner provided for the execution of deeds of real property, and (3) declare the disclaimer and the extent thereof.
• Conn. Gen. Stat. § 45a-579(d) — time limitation, delivery, and recording.
• Conn. Gen. Stat. § 45a-579(e) — effect of disclaimer; the disclaimer relates back for all purposes to the date of death (§ 45a-579(e)(5)).
• Conn. Gen. Stat. § 45a-580 — disclaimer of interests arising under nontestamentary instruments (trusts, insurance, accounts, beneficiary designations).
• 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2 — federal qualified-disclaimer requirements.

4. THE DISCLAIMER

The Disclaimant hereby irrevocably 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, and declares this disclaimer and the extent thereof as required by Conn. Gen. Stat. § 45a-579(c):

☐ 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 Disclaimant makes this Disclaimer freely and voluntarily, for no consideration, and not at the direction of any other person. This Disclaimer describes the interest disclaimed and is executed in the manner provided for the execution of deeds of real property under the laws of this state.

5. QUALIFIED-DISCLAIMER REPRESENTATIONS (IRC § 2518)

The Disclaimant represents and certifies that:

☐ This Disclaimer is in writing and executed in the manner provided for deeds of real property (Conn. Gen. Stat. § 45a-579(c); Treas. Reg. § 25.2518-2(b)).
☐ This Disclaimer is being delivered within nine (9) months after the later of (a) the death of the decedent / donee of the power, or (b) the day the Disclaimant attained age 18 (Conn. Gen. Stat. § 45a-579(d)(1)); and within nine (9) months for federal purposes measured from the later of the transfer or the date the Disclaimant attained age 21 (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 devolves as if the Disclaimant had predeceased the deceased owner or the donee of the power of appointment (Conn. Gen. Stat. § 45a-579(e)(2)(A)).
☐ This Disclaimer is irrevocable (Conn. Gen. Stat. § 45a-578(c)).

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under Conn. Gen. Stat. § 45a-579(e), if the deceased owner (or donee of the power) has not provided another disposition in the event of a disclaimer, the disclaimed interest devolves as if the Disclaimant, a natural person acting for himself or herself, had predeceased the deceased owner or the donee of the power of appointment (§ 45a-579(e)(2)(A)). The Disclaimer relates back for all purposes to the date of death of the deceased owner or donee of the power (§ 45a-579(e)(5)).

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

Under Conn. Gen. Stat. § 45a-578(c), a disclaimer that complies with Chapter 802g is irrevocable. This Disclaimer is binding upon the Disclaimant and the Disclaimant's heirs, successors, assigns, agents, and personal representatives. The Disclaimant has not assigned, transferred, encumbered, pledged, accepted, or otherwise disposed of the disclaimed interest, and has done no act constituting acceptance of the interest.

8. DELIVERY, FILING, AND RECORDING (Conn. Gen. Stat. § 45a-579(d))

The Disclaimant will deliver and record this Disclaimer as follows (check all that apply):

☐ Delivery (§ 45a-579(d)(3)): Deliver to the legal representative of the estate of the decedent or deceased donee of the power, or to the holder of legal title to the property to which the interest relates, not later than the date which is nine (9) months after the later of the decedent's/donee's death or the day the Disclaimant attained age 18 (present interest; § 45a-579(d)(1)).
☐ Nontestamentary interest (§ 45a-580): Deliver to the trustee, insurer, plan administrator, financial institution, or other person holding legal title to or obligated to distribute the interest.
☐ Real property — recording (§ 45a-579(d)(4)): If an interest in real property is disclaimed, a copy will be recorded in the office of the Town Clerk of the Town of [TOWN], Connecticut, where the real property is situated, within the nine-month period. (If not so recorded, the disclaimer is ineffective against any person other than the Disclaimant as to that real-property interest.)
☐ Probate Court (optional, conclusive evidence; § 45a-579(d)): File a copy of this Disclaimer, together with a receipt executed by the legal representative or holder of legal title (in the manner provided for the disclaimer), in the Probate Court for the District of [____________] within the nine-month period as conclusive evidence of timely disclaimer.

9. SIGNATURE AND ACKNOWLEDGMENT

Signed, sealed, and delivered on [__/__/____], at [TOWN], Connecticut, in the presence of the witnesses below.

Disclaimant Signature: ______________________________________

Printed Name: [____________________________________]

Witness 1: ______________________________________ Printed: [____________________]

Witness 2: ______________________________________ Printed: [____________________]

Notary Acknowledgment

State of Connecticut, County of [____________________]

On [__/__/____], before me, the undersigned officer, personally appeared [DISCLAIMANT NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she/they executed the same for the purposes therein contained, as a free act and deed.

In witness whereof I hereunto set my hand.

Notary Public / Commissioner of the Superior Court: ______________________________________ [SEAL]

My commission expires: [__/__/____]

10. VERIFICATION / DECLARATION

I, [DISCLAIMANT NAME], declare under penalty of false statement under the laws of the State of Connecticut 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 [TOWN], Connecticut.

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]
Connecticut Juris 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 nontestamentary instrument / beneficiary designation (insurance, annuity, account)
☐ Legal description of real property (Exhibit A) — if real property is disclaimed
☐ Certified copy of the Decedent's Death Certificate
☐ Receipt of delivery executed by the legal representative or holder of legal title (for § 45a-579(d) conclusive-evidence filing)
☐ Recorded copy from the Town Clerk's land records (if real property disclaimer was recorded)

SOURCES AND REFERENCES

• Conn. Gen. Stat. §§ 45a-578 to 45a-585 (Chapter 802g — Disclaimer of Property) — Connecticut General Assembly: https://www.cga.ct.gov
• Conn. Gen. Stat. §§ 45a-578, 45a-579, 45a-580.
• 26 U.S.C. § 2518 (qualified disclaimers); Treas. Reg. § 25.2518-2 (requirements).