Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Nevada

TIMING — IRC § 2518 (9-MONTH DEADLINE): To qualify as a federal "qualified disclaimer," this writing must be signed and received by the proper recipient by the nine-month date measured from the later of the transfer creating this interest or the disclaimant's 21st birthday (subject to the limited federal mailing and weekend/holiday rules in Treas. Reg. § 25.2518-2(c)(2)), with no acceptance of the interest or its benefits. Nevada's Uniform Disclaimer of Property Interests Act (NRS ch. 120) does not itself set a 9-month state deadline. NRS 120.310 treats a disclaimer that meets the federal tax rule as effective under Nevada's chapter. Verify the deadline with counsel before signing.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

STATE OF NEVADA

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 the person to whom the disclaimed interest or power would have passed had this disclaimer not been made (NRS 120.120), namely a(n): ☐ heir ☐ devisee ☐ legatee ☐ beneficiary under a testamentary or nontestamentary instrument ☐ surviving joint tenant or surviving holder of jointly held property ☐ donee or appointee under a power of appointment ☐ beneficiary of a beneficiary designation (insurance, annuity, retirement plan, POD/TOD) ☐ taker in default of exercise of a power ☐ 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
☐ Revocable, testamentary, or inter vivos trust
☐ Beneficiary designation (life insurance, retirement plan, annuity, POD/TOD account, or security registered in beneficiary form)
☐ Jointly held property with right of survivorship (NRS 120.240)
☐ Other identified property interest: [________________________________]
☐ Power of appointment (NRS 120.260; 120.270)
☐ Other: [________________________________]

Extent of the disclaimer:
☐ Full disclaimer — the Disclaimant disclaims the entire interest or power described above.
☐ Partial disclaimer — the Disclaimant disclaims only the following fraction, percentage, monetary amount, term of years, limitation of a power, or other interest or estate (NRS 120.220): [____________________] (e.g., an undivided ____% interest, or the sum of $[____________]).

Federal partial-disclaimer check: The listed state-law partial forms do not automatically qualify for federal tax treatment. An undivided fraction or percentage must include every substantial right in the separate interest for its entire term; a stated monetary amount requires segregation of that amount and its income without benefit to the Disclaimant. A disclaimer of an income interest for a limited number of years does not qualify. Check the selected portion under Treas. Reg. § 25.2518-3 before treating this instrument as federally qualified.

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

3. STATUTORY AUTHORITY

This Disclaimer is made under the Uniform Disclaimer of Property Interests Act (1999), NRS Chapter 120, and seeks federal qualified disclaimer treatment only if the selected interest and portion satisfy 26 U.S.C. § 2518 and Treas. Reg. §§ 25.2518-2 and 25.2518-3.

• NRS 120.220 authorizes a person to disclaim, in whole or in part, any interest in or power over property, including a power of appointment, even if its creator imposed a spendthrift provision or other restriction; it 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 NRS 120.290.
• NRS 120.290 prescribes to whom and how a disclaimer must be delivered or filed, depending on the type of interest (intestacy/will, testamentary trust, inter vivos trust, beneficiary designation, jointly held property, power of appointment).
• NRS 120.300 governs when a disclaimer is barred or limited (e.g., by acceptance of the interest or its benefits).
• NRS 120.310 makes a disclaimer or transfer treated as never transferred to the Disclaimant under federal transfer-tax law effective under Nevada's chapter.
• NRS 120.320 governs the recording of a disclaimer of an interest in real property.

4. THE DISCLAIMER

The Disclaimant, intending to be legally bound, hereby IRREVOCABLY DISCLAIMS and RENOUNCES all (or, where a partial disclaimer is elected in Section 2, the stated fraction, percentage, monetary amount, or portion of all) right, title, claim, interest, and power 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 other record, declares the disclaimer, describes the interest or power disclaimed, and is signed by the Disclaimant (or the Disclaimant's legal representative), as required by NRS 120.220 and Treas. Reg. § 25.2518-2(b).

☐ This Disclaimer is delivered or filed by the Nevada method applicable to this interest under NRS 120.290, and the writing is received within nine (9) months after the later of the transfer creating this interest or the Disclaimant's 21st birthday for federal qualified-disclaimer treatment (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 (NRS 120.300; Treas. Reg. § 25.2518-2(d)).

☐ The Disclaimant has not waived the right to disclaim in writing, and no judicial sale of the disclaimed interest has occurred before this Disclaimer becomes effective (NRS 120.300).

☐ 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)).

☐ The disclaimed interest passes under the governing instrument's disclaimer provision, if any, or the applicable default in NRS 120.230; a surviving joint holder's disclaimer follows NRS 120.240.

☐ This Disclaimer is intended as a tax-qualified disclaimer under 26 U.S.C. § 2518, consistent with NRS 120.310.

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

For an ordinary property interest governed by NRS 120.230, the instrument's disclaimer disposition controls first. If it gives none, the applicable statutory default controls, including the special rules for a disclaimant's surviving descendants and an interest that otherwise would pass to the disclaimant's estate. The disclaimer takes effect when the creating instrument becomes irrevocable or, for an intestate interest, at death. NRS 120.240 separately governs a surviving joint holder's disclaimer. Other interests and powers follow their applicable NRS Chapter 120 provisions.

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

7. IRREVOCABILITY AND BINDING EFFECT

Under NRS 120.220, this Disclaimer becomes irrevocable when it is delivered or filed (or when it becomes effective as provided in the Act), whichever occurs later, and may not thereafter be modified, withdrawn, or rescinded. It is binding upon the Disclaimant and all persons claiming through or under the Disclaimant.

8. DELIVERY, FILING, AND RECORDING

Choose the Nevada route for the interest actually disclaimed. NRS 120.290(2)–(11) identifies the recipient or court. Complete the name, address, and proof of delivery below; do not assume that mailing to one recipient satisfies every route.

☐ Will or intestacy, excluding testamentary trust: Deliver to the estate's serving personal representative; if none serves, file with a court authorized to appoint one.

☐ Testamentary trust: Deliver to the serving trustee; if none serves, deliver to the estate's personal representative; if neither serves, file with a court authorized to enforce the trust.

☐ Inter vivos trust: Deliver to the serving trustee; if none serves, file with a court authorized to enforce the trust. Before the creating instrument becomes irrevocable, delivery to the settlor of a revocable trust or the transferor of the interest is also a statutory route.

☐ Beneficiary designation before irrevocability: Deliver to the person who made the designation.

☐ Beneficiary designation after irrevocability, personal property: Deliver to the person obligated to distribute the interest.

☐ Beneficiary designation after irrevocability, real property: Record in the county where the real property is located under NRS 120.290(6)(b). County and recording details: [________________________________].

☐ Surviving holder of jointly held property: Deliver to the person to whom the disclaimed interest passes.

☐ Object or taker in default of a power of appointment: Deliver to the power holder or the fiduciary under the creating instrument; if no fiduciary serves, file with a court authorized to appoint one.

☐ Appointee of a nonfiduciary power: Deliver to the power holder, that holder's personal representative, or the fiduciary under the creating instrument; if no fiduciary serves, file with a court authorized to appoint one.

☐ Fiduciary disclaiming a power over a trust or estate: Use the applicable will, testamentary-trust, or inter vivos-trust route above.

☐ Agent disclaiming a power: Deliver to the principal or the principal's representative.

For Nevada delivery, NRS 120.290(1) permits personal delivery, first-class mail, or another method likely to result in receipt, subject to the route above. NRS 120.320 permits recording an eligible disclaimer; it does not require recording every disclaimer involving real property. Record here, if appropriate: [COUNTY; INSTRUMENT NUMBER / NOT APPLICABLE].

Separate federal tax-delivery check: For intended treatment under 26 U.S.C. § 2518, send the signed writing to a recipient permitted by Treas. Reg. § 25.2518-2(b)(2): the transferor, the transferor's legal representative, the holder of legal title, or the person in possession of the property. The applicable Nevada and federal recipients may differ. Federal recipient, capacity, address, and receipt date: [________________________________]. If relying on timely mailing or a weekend or legal-holiday rule, document compliance with Treas. Reg. § 25.2518-2(c)(2): [________________________________].

9. SIGNATURE AND OPTIONAL ACKNOWLEDGMENT

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

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

OPTIONAL ACKNOWLEDGMENT — complete when recording or the recipient requires it. Nevada's disclaimer statute does not impose a general notarization condition on every disclaimer.

STATE OF NEVADA )
COUNTY OF [____________] )

This instrument was acknowledged before me on this [____] day of [____________], 20[____], by [DISCLAIMANT FULL LEGAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, who acknowledged before me that he/she executed the same voluntarily.

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

[NOTARY SEAL]

10. OPTIONAL VERIFICATION / DECLARATION

I, [DISCLAIMANT FULL LEGAL NAME], declare under penalty of perjury under the laws of the State of Nevada 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 this signed Disclaimer was delivered (in person, by first-class mail, or by registered or certified mail, return receipt requested) 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, if recording was required or chosen under Section 8
☐ File-stamped copy from the District Court (probate proceeding)

SOURCES AND REFERENCES

• Uniform Disclaimer of Property Interests Act (1999), NRS Chapter 120 — https://www.leg.state.nv.us/nrs/nrs-120.html
• NRS 120.290 (Delivery or filing) — https://www.leg.state.nv.us/nrs/nrs-120.html#NRS120Sec290
• NRS 120.320 (Recording of disclaimer) — https://www.leg.state.nv.us/nrs/nrs-120.html#NRS120Sec320
• 26 U.S.C. § 2518 (Disclaimers) — https://uscode.house.gov/us/usc/119-136/t26/s2518/
• Treas. Reg. § 25.2518-2 (Requirements for a qualified disclaimer) — https://www.govinfo.gov/content/pkg/CFR-2025-title26-vol16/xml/CFR-2025-title26-vol16-sec25-2518-2.xml
• Treas. Reg. § 25.2518-3 (Partial-interest disclaimers) — https://www.govinfo.gov/content/pkg/CFR-2025-title26-vol16/xml/CFR-2025-title26-vol16-sec25-2518-3.xml