Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Missouri

Before you use this: Federal qualified-disclaimer treatment requires timely receipt of the signed writing by an authorized recipient within nine months after the later of the transfer creating the interest or the disclaimant's 21st birthday, without prior acceptance or direction of its passage (26 U.S.C. § 2518(b)). Missouri separately requires delivery within nine months after the transfer, unless a later time applies under the particular transfer or Chapter 469, and before acceptance (§ 469.020.1). A revocable transfer is not a transfer for this chapter until the power to revoke ends (§ 469.040); contingent interests and interests vested before age 21 have additional timing rules (§§ 469.070, 469.100). Determine both deadlines and the applicable delivery route before signing.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

STATE OF MISSOURI

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 an individual to whom property or an interest therein has been donatively transferred by any means, and who may disclaim under Mo. Rev. Stat. § 469.010, namely a(n): ☐ heir ☐ devisee ☐ legatee ☐ grantee ☐ donee ☐ surviving joint tenant ☐ beneficiary under a governing instrument or contract ☐ appointee under 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 (Mo. Rev. Stat. ch. 474)
☐ 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 transfer described above.
☐ Partial disclaimer — the Disclaimant disclaims only the following fractional, percentage, or pecuniary portion of the transfer: [____________________] (e.g., an undivided ____% interest, or the sum of $[____________]). Under Mo. Rev. Stat. § 469.010, a disclaimed portion passes to the same ultimate taker(s) and in the same proportions as a disclaimer of all of the transfer.

For federal qualified-disclaimer treatment, an undivided fraction must cover the same fraction of every substantial right for the full term. A disclaimed pecuniary amount and its income must be segregated, with no benefit to the disclaimant. (26 C.F.R. § 25.2518-3(b)–(c)).

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

3. STATUTORY AUTHORITY

This Disclaimer is made under Chapter 469 of the Revised Statutes of Missouri (Disclaimers of Property) and is intended to constitute a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2.

• Mo. Rev. Stat. § 469.010 permits an individual to disclaim all or part of a donative transfer and describes how the disclaimed interest passes.
• Mo. Rev. Stat. § 469.020.1 requires that the disclaimer be made by a writing showing an unconditional refusal to accept a transfer (or a portion of it), signed by the Disclaimant or representative, and delivered on or before nine (9) months after the transfer (or by any later time provided in the particular case or under chapter 469), and before any acceptance of the disclaimed interest.
• Mo. Rev. Stat. § 469.020.2 preserves the right to disclaim notwithstanding any contrary intention of the transferor and notwithstanding any spendthrift provision or similar restriction.

4. THE DISCLAIMER

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

This Disclaimer is made freely and voluntarily.

5. QUALIFIED-DISCLAIMER REPRESENTATIONS

The Disclaimant represents and certifies that:

☐ This Disclaimer is in writing, shows an unconditional refusal to accept, and is signed by the Disclaimant (or representative), as required by Mo. Rev. Stat. § 469.020.1 and Treas. Reg. § 25.2518-2(b).

☐ The Disclaimant has NOT accepted the disclaimed interest or any of its benefits within the meaning of Mo. Rev. Stat. § 469.030, and has taken no act that would preclude a later disclaimer (Treas. Reg. § 25.2518-2(d)).

☐ The disclaimed interest passes without any direction by the Disclaimant to the decedent's spouse or to a person other than the Disclaimant (26 U.S.C. § 2518(b)(4); Treas. Reg. § 25.2518-2(e)).

☐ Unless the transfer terms provide otherwise, this Disclaimer applies those terms as if the Disclaimant had died immediately before the transfer, and the disclaimed interest passes directly from the transferor to the ultimate taker(s) (Mo. Rev. Stat. § 469.010).

☐ This Disclaimer is intended as a qualified disclaimer under 26 U.S.C. § 2518 and the regulations thereunder.

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under Mo. Rev. Stat. § 469.010, unless the terms of the transfer provide otherwise, the disclaimed transfer and later interests are treated as if the Disclaimant had died immediately before the transfer, subject to the section's protections for later-born children and undisclaimed future interests. The interest is deemed to pass directly from the transferor to the ultimate taker or takers. A disclaimed portion passes in the same proportions as a disclaimer of the entire transfer. This document does not determine the treatment of creditors or public benefits under other applicable law.

For a nonprobate transfer, Mo. Rev. Stat. § 461.048 treats the disclaimant as having predeceased the owner unless the beneficiary designation provides otherwise.

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

7. IRREVOCABILITY AND BINDING EFFECT

The Disclaimant makes this refusal irrevocably for purposes of 26 U.S.C. § 2518(b). Under Mo. Rev. Stat. § 469.030, acceptance of the interest or a portion of it precludes a later disclaimer of that accepted interest. The Disclaimant represents that no such acceptance has occurred.

8. DELIVERY, FILING, AND RECORDING

Identify and complete the delivery route that applies to this interest under Mo. Rev. Stat. § 469.020.1. Record the actual recipient and date below:

☐ Deliver this Disclaimer to the transferor.

☐ Deliver this Disclaimer to the transferor's personal representative or other legal representative (e.g., the executor or administrator of a deceased transferor's estate).

☐ Deliver this Disclaimer to the holder of the legal title to the property to which the interest relates (for property passing under a nontestamentary instrument or contract).

☐ File, if applicable, in the Probate Division of the Circuit Court of [____________] County, Missouri. Section 469.020.1 permits filing there for an estate or property within that division's jurisdiction; it does not require every disclaimer to be filed there.

☐ Record, if needed for the real-property title record, with the Recorder of Deeds of [____________] County, Missouri. Confirm the local recording requirements; Chapter 469 does not make recording a general condition of a disclaimer.

Completion record — fill after execution and delivery, not as a signer certification: State filing, delivery, or recording completed as applicable: [METHOD / DATE / PROOF]. For federal qualification under 26 U.S.C. § 2518(b)(2), authorized recipient: [________]; actual receipt date: [________]; receipt proof: [________]. Check the federal deadline measured from the transfer creating the interest or age 21, whichever is later, and any timely-mailing or weekend/holiday rule under Treas. Reg. § 25.2518-2(c)(2).

9. SIGNATURE, ACKNOWLEDGMENT, AND NOTARIZATION

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

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

ACKNOWLEDGMENT

STATE OF MISSOURI )
COUNTY OF [____________] )

On this [____] day of [____________], 20[____], before me personally appeared [DISCLAIMANT FULL LEGAL NAME], to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.

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

[NOTARY SEAL]

10. VERIFICATION / DECLARATION

I, [DISCLAIMANT FULL LEGAL NAME], confirm that the statements in this Disclaimer are true to the best of my knowledge, that I have not accepted the disclaimed interest or its benefits, and that I sign voluntarily.

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 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
☐ Copy of the recorded Disclaimer (Recorder of Deeds), if real property is involved
☐ File-stamped copy from the Probate Division (Circuit Court), if filed

SOURCES AND REFERENCES

• Missouri Revised Statutes, Chapter 469 (Disclaimers of Property), §§ 469.010 to 469.120 — https://revisor.mo.gov/main/OneChapter.aspx?chapter=469
• Mo. Rev. Stat. § 469.020 (Disclaimer, how and when made; delivery) — https://revisor.mo.gov/main/OneSection.aspx?section=469.020
• 26 U.S.C. § 2518 (Disclaimers) — https://uscode.house.gov/us/usc/119-120/t26/s2518/
• Treas. Reg. § 25.2518-2 (Requirements for a qualified disclaimer) — https://www.ecfr.gov/current/title-26/section-25.2518-2