Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Indiana

TIMING — IRC § 2518 (9-MONTH FEDERAL DEADLINE): Indiana's UDPIA (Ind. Code § 32-17.5) imposes no fixed statutory deadline to disclaim, but the right is barred once the interest is accepted. To qualify as a federal "qualified disclaimer," this writing must nonetheless be signed and delivered within nine (9) months after the date of the decedent's death or other transfer (or within 9 months after the disclaimant turns 21), with no acceptance of the interest or its benefits. Verify the deadline with counsel before signing.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

STATE OF INDIANA

TABLE OF CONTENTS

1. Disclaimant Information
2. Identification of the Transfer and Interest Disclaimed
3. Statutory Authority
4. The Disclaimer
5. Qualified-Disclaimer Representations
6. Effect and Passing of the Disclaimed Interest
7. Irrevocability and Binding Effect
8. Delivery, Filing, and Recording
9. Signature, Acknowledgment, and Notarization
10. Verification / Declaration
11. Certificate of Delivery / Service
12. Attachments Checklist

1. DISCLAIMANT INFORMATION

The undersigned (the "Disclaimant") is a person to whom a disclaimed interest or power would have passed had the disclaimer not been made (Ind. Code § 32-17.5-2-2), namely a(n): ☐ heir ☐ devisee ☐ beneficiary under a testamentary or nontestamentary instrument ☐ surviving joint owner / surviving joint tenant ☐ beneficiary under a beneficiary designation ☐ donee / appointee / taker in default under a power of appointment ☐ fiduciary ☐ other: [____________________].

2. IDENTIFICATION OF THE TRANSFER AND INTEREST DISCLAIMED

Source of the interest (check all that apply):
☐ Last Will and Testament of the Decedent
☐ Intestate succession (Ind. Code Title 29)
☐ Revocable or testamentary trust
☐ Beneficiary designation (life insurance, retirement plan, annuity, POD/TOD account, or security registered in beneficiary form)
☐ Joint tenancy with right of survivorship
☐ Power of appointment
☐ Other: [________________________________]

Extent of the disclaimer:
☐ Full disclaimer — the Disclaimant disclaims the entire interest described above.
☐ Partial disclaimer — the Disclaimant disclaims only the following fractional, percentage, pecuniary, or otherwise described portion: [____________________] (e.g., an undivided ____% interest, or the sum of $[____________]).

Legal description of any real property disclaimed (or see attached Exhibit A): [________________________________]

3. STATUTORY AUTHORITY

This Disclaimer is made under the Indiana Uniform Disclaimer of Property Interests Act, Ind. Code § 32-17.5-1 et seq., and is intended to constitute a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2.

• Ind. Code § 32-17.5-3-1 authorizes a person to disclaim, in whole or in part, any interest in or power over property, whenever and however acquired, even if the creator imposed a spendthrift provision or similar restriction.
• Ind. Code § 32-17.5-3-3 requires that a disclaimer be in a writing or other record, declare the disclaimer, describe the interest or power disclaimed, be signed by the person making the disclaimer, and be delivered or filed as provided in Ind. Code § 32-17.5-7.
• Ind. Code § 32-17.5-9 preserves the ability to make a disclaimer that meets the requirements of a tax-qualified (federal) disclaimer under 26 U.S.C. § 2518.

4. THE DISCLAIMER

The Disclaimant, intending to be legally bound, hereby IRREVOCABLY and UNQUALIFIEDLY DISCLAIMS and RENOUNCES all (or, where a partial disclaimer is elected in Section 2, the stated fractional, percentage, or pecuniary part of all) right, title, claim, and interest of every kind — whether vested or contingent, present or future, legal or equitable — in and to the property and interest described in Section 2 above.

This Disclaimer is made freely, voluntarily, and with full knowledge of its legal and tax consequences.

5. QUALIFIED-DISCLAIMER REPRESENTATIONS

The Disclaimant represents and certifies that:

☐ This Disclaimer is in a writing or record, declares the disclaimer, describes the interest, and is signed by the Disclaimant, as required by Ind. Code § 32-17.5-3-3 and Treas. Reg. § 25.2518-2(b).

☐ This Disclaimer is being delivered and/or filed within nine (9) months after the later of (a) the date of the Decedent's death or the date the instrument creating the interest became irrevocable, or (b) 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, and has not assigned, conveyed, encumbered, pledged, transferred, or contracted to transfer the interest (Ind. Code § 32-17.5-8; Treas. Reg. § 25.2518-2(d)).

☐ The disclaimed interest passes without any direction on the part of the Disclaimant (26 U.S.C. § 2518(b)(4); Treas. Reg. § 25.2518-2(e)).

☐ As a result of this Disclaimer, the interest passes as if the Disclaimant had died immediately before the time of distribution (or as the governing instrument otherwise directs), as provided by Ind. Code § 32-17.5-4-1.

☐ This Disclaimer is intended as a qualified disclaimer under 26 U.S.C. § 2518 (see Ind. Code § 32-17.5-9).

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under Ind. Code § 32-17.5-4-1, a disclaimer of an interest in property takes effect when the instrument creating the interest becomes irrevocable, or upon the intestate's death if the interest arose under intestate succession. If the instrument creating the interest provides for the disposition of a disclaimed interest (or concerns disclaimed interests generally), the disclaimed interest passes according to that provision. Otherwise, if the Disclaimant is an individual, the disclaimed interest passes as if the Disclaimant had died immediately before the time of distribution; where the Disclaimant's descendants would share by representation, the interest passes only to the descendants who survive at the time of distribution.

The Disclaimant does not direct to whom the disclaimed interest passes; it passes solely by operation of the governing instrument and Indiana law.

7. IRREVOCABILITY AND BINDING EFFECT

This Disclaimer is irrevocable once it is delivered or filed (Ind. Code § 32-17.5-3-1). It may not be modified, withdrawn, or rescinded, and is binding upon the Disclaimant and all persons claiming through or under the Disclaimant.

8. DELIVERY, FILING, AND RECORDING

Pursuant to Ind. Code § 32-17.5-7, the Disclaimant shall (check all that apply):

☐ Deliver this Disclaimer to the personal representative of the Decedent's estate, for an interest created by intestate succession or by will (other than an interest in a testamentary trust) (Ind. Code § 32-17.5-7-2(1)).

☐ File this Disclaimer with a court having jurisdiction to appoint the personal representative, if no personal representative is then serving (Ind. Code § 32-17.5-7-2(2)).

☐ Deliver this Disclaimer to the trustee then serving (for an interest in a testamentary or inter vivos trust) or to the person obligated to distribute the interest (for a beneficiary designation), as applicable under Ind. Code § 32-17.5-7-3 through 32-17.5-7-7.

☐ Record a copy of this Disclaimer in the Office of the Recorder of [____________] County, Indiana, where the real property is located, if an interest in real property is disclaimed.

9. SIGNATURE, ACKNOWLEDGMENT, AND NOTARIZATION

Executed this [____] day of [____________], 20[____].

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

ACKNOWLEDGMENT

STATE OF INDIANA )
COUNTY OF [____________] )

On this [____] day of [____________], 20[____], before me, the undersigned Notary Public, personally appeared [DISCLAIMANT FULL LEGAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged the execution of the same to be his/her voluntary act and deed.

______________________________________
Notary Public
County of Residence: [____________]
My commission expires: [__/__/____]

[NOTARY SEAL]

10. VERIFICATION / DECLARATION

I, [DISCLAIMANT FULL LEGAL NAME], affirm under the penalties for perjury under the laws of the State of Indiana that the foregoing is true and correct, that I have not accepted the disclaimed interest or any benefit thereof, and that I make this Disclaimer of my own free will.

Signature: ______________________________________
Date: [__/__/____]

11. CERTIFICATE OF DELIVERY / SERVICE

I certify that on the date(s) shown below a true and correct copy of this Disclaimer was delivered (in person, or by registered or certified mail, return receipt requested, or other method likely to result in receipt) to the following:

Signature: ______________________________________
Printed Name: [________________________________]

12. ATTACHMENTS CHECKLIST

☐ Copy of the Last Will and Testament, trust instrument, or beneficiary designation creating the disclaimed interest
☐ Exhibit A — legal description of any real property disclaimed
☐ Certified copy of the Decedent's Death Certificate
☐ Proof of delivery / mailing (registered or certified mail receipts)
☐ Copy of the recorded Disclaimer (County Recorder), if real property is involved
☐ File-stamped copy from the probate court (estate proceeding)

SOURCES AND REFERENCES

• Indiana Uniform Disclaimer of Property Interests Act, Ind. Code Title 32, Article 17.5 — https://law.justia.com/codes/indiana/title-32/article-17-5/
• Ind. Code § 32-17.5-4-1 (Effect of disclaimer) — https://codes.findlaw.com/in/title-32-property/in-code-sect-32-17-5-4-1/
• Ind. Code § 32-17.5-7-2 (Delivery — intestate / will) — https://law.justia.com/codes/indiana/title-32/article-17-5/chapter-7/section-32-17-5-7-2/
• 26 U.S.C. § 2518 (Disclaimers) — https://www.law.cornell.edu/uscode/text/26/2518
• Treas. Reg. § 25.2518-2 (Requirements for a qualified disclaimer) — https://www.law.cornell.edu/cfr/text/26/25.2518-2