Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Massachusetts

TIMING — 9-MONTH DEADLINE (G.L. c. 190B, § 2-801(c) AND IRC § 2518): Under Massachusetts law this disclaimer must be executed and filed within nine (9) months after the event determining that the beneficiary is finally ascertained and the interest is indefeasibly vested (for a surviving joint tenant or tenant by the entirety, within 9 months after the other tenant's death). The court may grant an extension on petition. Independently, to be a federal "qualified disclaimer" under 26 U.S.C. § 2518, the writing must be received by the transferor, legal representative, or legal-title holder within nine (9) months after the later of the transfer creating the interest or the disclaimant's 21st birthday, with no acceptance of the interest or its benefits. Verify the deadline with counsel before signing.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

COMMONWEALTH OF MASSACHUSETTS

TABLE OF CONTENTS

1. Beneficiary / 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. Filing, Recording, and Service
9. Signature, Acknowledgment, and Notarization
10. Verification / Declaration
11. Certificate of Delivery / Service
12. Attachments Checklist

1. BENEFICIARY / DISCLAIMANT INFORMATION

The undersigned (the "Beneficiary" or "Disclaimant") is a beneficiary within the meaning of G.L. c. 190B, § 2-801(a) to whom an interest in property would pass but for this Disclaimer, namely a(n): ☐ heir ☐ devisee ☐ legatee ☐ beneficiary of a testamentary or inter vivos trust ☐ donee/grantee ☐ beneficiary of an insurance or annuity contract ☐ surviving joint tenant or tenant by the entirety ☐ donee of a power of appointment ☐ 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 (G.L. c. 190B, Article II)
☐ Testamentary trust
☐ Inter vivos trust
☐ Beneficiary designation (life insurance, annuity, retirement plan, POD/TOD account, or security registered in beneficiary form)
☐ Joint tenancy or tenancy by the entirety 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, or pecuniary portion: [____________________] (e.g., an undivided ____% interest, or the sum of $[____________]). Disclaimer of part of an interest does not bar disclaiming any other part (G.L. c. 190B, § 2-801(h)).

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

3. STATUTORY AUTHORITY

This Disclaimer is made under G.L. c. 190B, § 2-801 (Massachusetts Uniform Probate Code) and is intended to constitute a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2.

• G.L. c. 190B, § 2-801(b) permits a beneficiary, unless barred under subsection (h), to disclaim any interest in property that would otherwise pass to the beneficiary by intestate succession, devise, legacy, bequest, exercise or nonexercise of a power of appointment, or as donee, grantee, trust beneficiary, insurance/annuity beneficiary, or surviving joint tenant or tenant by the entirety.
• G.L. c. 190B, § 2-801(c) requires the disclaimer to be executed and filed not later than nine (9) months after the event determining that the beneficiary is finally ascertained and the interest is indefeasibly vested (subject to court extension).
• G.L. c. 190B, § 2-801(d) requires the disclaimer to be in writing, describe the interest disclaimed, declare the disclaimer and its extent, be clear and unequivocal, and be signed by the beneficiary (or authorized representative).
• G.L. c. 190B, § 2-801(e) requires filing with the appropriate Probate Court and, for real property, acknowledgment in the manner provided for deeds and recording in the Registry of Deeds.

4. THE DISCLAIMER

The Disclaimant, intending to be legally bound, hereby IRREVOCABLY, CLEARLY, and UNEQUIVOCALLY 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 legal or equitable, present, future, or contingent — 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 writing, describes the interest disclaimed, declares the disclaimer and its extent, is clear and unequivocal, and is signed by the Disclaimant, as required by G.L. c. 190B, § 2-801(d) and Treas. Reg. § 25.2518-2(b).

☐ State delivery, filing, or recording requirements stated above have been checked and completed: [METHOD / DATE / PROOF].
☐ For 26 U.S.C. § 2518(b)(2), the written refusal was received by the transferor, the transferor's legal representative, or the holder of legal title within nine months after the later of the transfer creating the interest or the disclaimant's 21st birthday: [RECIPIENT / DATE / RECEIPT PROOF].

☐ The right to disclaim is NOT barred under G.L. c. 190B, § 2-801(h): the Disclaimant has not assigned, conveyed, encumbered, pledged, or transferred the interest or contracted to do so; is not insolvent at the time of this disclaimer; has not executed a written waiver of the right to disclaim; and has not accepted the interest or, having knowledge of it, received any benefit from it without objection.

☐ 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 preceding the event determining that the Disclaimant is the beneficiary and that the interest is indefeasibly vested, and shall never vest in the Disclaimant (G.L. c. 190B, § 2-801(g)).

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under G.L. c. 190B, § 2-801(g), unless such a result would substantially impair the provisions or intent of the governing instrument, statute, or rule of law, the disclaimed interest passes in the same manner as if the Disclaimant had died immediately preceding the event determining that the Disclaimant is the beneficiary of such interest and that the interest is indefeasibly vested. The interest being disclaimed shall never vest in the Disclaimant. Where the interest disclaimed is a power to appoint, consume, apply, or expend property, that power is extinguished.

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

7. IRREVOCABILITY AND BINDING EFFECT

A disclaimer complying with G.L. c. 190B, § 2-801 is effective according to its terms and irrevocable upon execution under subsection (d) and filing under subsection (e). This Disclaimer may not be modified, withdrawn, or rescinded thereafter. The right to disclaim exists notwithstanding any express or implied spendthrift provision or similar restraint on alienation (G.L. c. 190B, § 2-801(i)). This Disclaimer is binding upon the Disclaimant and the heirs and devisees of the Disclaimant.

8. FILING, RECORDING, AND SERVICE

Pursuant to G.L. c. 190B, § 2-801(e), the Disclaimant shall (check all that apply):

☐ File the original of this Disclaimer (or an attested copy, if filing is required with more than one court) with the Probate and Family Court wherein a duly appointed fiduciary having custody or control of the property is required to file periodic accounts (the [____________] Division).

☐ Acknowledge this Disclaimer in the manner provided for deeds of real property and record the original (or an attested copy) in the Registry of Deeds for [____________] County / District, Massachusetts, where the real property is situated (or file and register it with the assistant recorder for the registry district, in the case of registered land), if real property or an interest in real property is disclaimed.

☐ Serve a copy of this Disclaimer by delivery in hand or by certified mail to the last known address of the person or entity having custody or possession of the property. (Failure to comply with service requirements does not affect the validity of the disclaimer; G.L. c. 190B, § 2-801(e).)

9. SIGNATURE, ACKNOWLEDGMENT, AND NOTARIZATION

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

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

ACKNOWLEDGMENT

COMMONWEALTH OF MASSACHUSETTS )
COUNTY OF [____________] )

On this [____] day of [____________], 20[____], before me, the undersigned Notary Public, personally appeared [DISCLAIMANT FULL LEGAL NAME], proved to me through satisfactory evidence of identification, which was [________________________________], to be the person whose name is signed on the foregoing instrument, and acknowledged to me that he/she signed it voluntarily for its stated purpose.

______________________________________
Notary Public
Printed Name: [________________________________]
My commission expires: [__/__/____]

[NOTARY SEAL]

10. VERIFICATION / DECLARATION

I, [DISCLAIMANT FULL LEGAL NAME], declare under the penalties of perjury under the laws of the Commonwealth of Massachusetts that the foregoing is true and correct, that none of the contingencies in G.L. c. 190B, § 2-801(h) that would bar my right to disclaim are applicable, 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 hand or by certified mail, return receipt requested) to the following person(s) or entity(ies) having custody or possession of the property:

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 service (certified mail return receipts)
☐ Copy of the recorded Disclaimer (Registry of Deeds), if real property is involved
☐ File-stamped copy from the Probate and Family Court
☐ Probate Court decree authorizing disclaimer for a beneficiary under disability or a deceased beneficiary (if applicable, G.L. c. 190B, § 2-801(b))

SOURCES AND REFERENCES

• G.L. c. 190B, § 2-801 (Disclaimer of Property Interests) — https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter190b/Section2-801
• Massachusetts Uniform Probate Code, c. 190B — https://malegislature.gov/Laws/GeneralLaws/PartII/TitleII/Chapter190b
• Former c. 191A repealed by St. 2008, c. 521, § 11 (superseded by c. 190B, § 2-801)
• 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