Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Rhode Island

Before signing: Confirm the separate Rhode Island execution and filing deadline under § 34-5-5 and federal receipt deadline under 26 U.S.C. § 2518. The state clock depends on the interest type; the federal clock generally runs from the transfer creating the interest or age 21, whichever is later. Verify the recipient, filing office, and any applicable state extension before relying on tax-qualified treatment.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

STATE OF RHODE ISLAND

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. When Irrevocable
8. Filing, Service, and Recording
9. Signature and Recording Acknowledgment
10. Verification / Declaration
11. Certificate of Delivery / Service
12. Attachments Checklist

1. DISCLAIMANT INFORMATION

The person identified above (the "Disclaimant") is a "beneficiary" within the meaning of R.I. Gen. Laws § 34-5-1 to whom an interest in property would pass under R.I. Gen. Laws § 34-5-2, namely a(n): ☐ heir / person taking by intestate succession ☐ devisee / legatee ☐ beneficiary of a testamentary trust ☐ donee / grantee ☐ beneficiary of an inter vivos trust ☐ beneficiary of an insurance or annuity contract ☐ surviving joint tenant or tenant by the entirety ☐ person succeeding to a disclaimed interest ☐ other: [____________________].

Signer, if different from Disclaimant: [____________________] Capacity: ☐ duly appointed guardian ☐ conservator ☐ legal representative of a deceased beneficiary's estate.

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
☐ Insurance or annuity contract
☐ Joint tenancy or tenancy by the entirety with right of survivorship
☐ Deed, assignment, or other nontestamentary instrument of conveyance
☐ Other: [________________________________]

Extent of the disclaimer:
☐ Full disclaimer — the Disclaimant disclaims the entire interest described above.
☐ Undivided fractional disclaimer — the Disclaimant disclaims an undivided [____]% of the entire interest described above (26 U.S.C. § 2518(c)(1)).
☐ Other partial disclaimer under Rhode Island law — the Disclaimant disclaims only [DESCRIBE SPECIFIC ASSET, DOLLAR AMOUNT, OR LESSER INTEREST]. Section 34-5-1 permits these state-law descriptions; confirm separately whether this portion meets federal qualified-disclaimer rules.

☐ If the interest is held in joint tenancy or tenancy by the entirety, the portion disclaimed excludes amounts the Disclaimant contributed to that interest (R.I. Gen. Laws § 34-5-2(a)(2)).

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

3. STATUTORY AUTHORITY

This Disclaimer is made under Rhode Island's disclaimer provisions, R.I. Gen. Laws §§ 34-5-1, 34-5-2, 34-5-4 through 34-5-6, 34-5-8, and 34-5-9, and is intended to constitute a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2 if all federal conditions are met.

• R.I. Gen. Laws § 34-5-2 authorizes a beneficiary, unless barred by § 34-5-9, to disclaim any interest in property that would otherwise pass to the beneficiary under a testamentary or nontestamentary instrument or by operation of law.
• R.I. Gen. Laws § 34-5-4 requires that the disclaimer be in writing, describe the interest in property being disclaimed, declare the disclaimer and the extent thereof, be clear and unequivocal, and be signed by the beneficiary, the beneficiary's duly appointed guardian or conservator, or the legal representative of a deceased beneficiary's estate.
• R.I. Gen. Laws § 34-5-5 sets separate nine-month periods for a present testamentary interest, present nontestamentary interest, future interest, and surviving joint interest. It also provides an age-21 rule and permits a court to extend the state execution and filing period on petition.
• For a revocable instrument, § 34-5-5(b) sets the effective date when the grantor can no longer revoke it or transfer the entire legal and equitable ownership. A state court extension does not itself extend the separate federal receipt deadline under 26 U.S.C. § 2518.

4. THE DISCLAIMER

The Disclaimant, intending to be legally bound, hereby CLEARLY, UNEQUIVOCALLY, and IRREVOCABLY DISCLAIMS and RENOUNCES the interest, or the precise portion of it selected in Section 2, in the property described 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, signed, clear and unequivocal, describes the interest disclaimed, and declares the disclaimer and its extent, as required by R.I. Gen. Laws § 34-5-4 and Treas. Reg. § 25.2518-2(b).

☐ Rhode Island deadline: This Disclaimer is executed and filed within the applicable § 34-5-5 period: ☐ present testamentary interest, nine months after death ☐ present nontestamentary interest, nine months after the instrument's effective date ☐ future interest, nine months after the event determining possession ☐ surviving joint interest, nine months after the other joint owner's death ☐ beneficiary under 21 at creation, nine months after reaching age 21 ☐ court-extended period under attached order. State deadline and basis: [____________________].

☐ Federal deadline and receipt: This writing is received by the transferor, transferor's legal representative, or holder of legal title within nine months after the later of the transfer creating the interest or the Disclaimant's 21st birthday (26 U.S.C. § 2518(b)(2)); any timely-mailing or weekend/holiday rule relied on is documented under Treas. Reg. § 25.2518-2(c)(2). Federal transfer date: [__/__/____]. Recipient and receipt or mailing evidence: [____________________].

☐ 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, and none of the contingencies in R.I. Gen. Laws § 34-5-9 that would waive or bar the right to disclaim is applicable (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)).

☐ The disclaimed interest passes under the governing instrument and R.I. Gen. Laws § 34-5-8 without the Disclaimant's direction; absent another disposition in the will or inter vivos instrument, it passes as if the Disclaimant had died immediately before the event determining the interest.

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under R.I. Gen. Laws § 34-5-8, unless the will or inter vivos instrument provides for another disposition, 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 the interest. Under that default rule, a future interest that takes effect at or after termination of the disclaimed interest takes effect as if the Disclaimant had so died, and the disclaimer relates back to that date. The disclaimed interest shall never vest in the Disclaimant (§ 34-5-8(c)).

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

7. WHEN IRREVOCABLE

Under R.I. Gen. Laws § 34-5-8(a), a disclaimer complying with all applicable chapter requirements is effective according to its terms and irrevocable upon execution under § 34-5-4 and filing under § 34-5-6.

8. FILING, SERVICE, AND RECORDING

Pursuant to R.I. Gen. Laws § 34-5-6, the Disclaimant shall (check all that apply):

☐ File the original (or an attested copy if filing with multiple offices) for personal property created by will with the probate court clerk that had jurisdiction of the decedent's estate at death; or, if created by an inter vivos instrument, with the Superior Court clerk for the county where the donor or grantor resided when creating the interest (Providence County if the donor or grantor was not a Rhode Island resident) (§ 34-5-6(a)(1)). Filing office: [____________________].

☐ File this Disclaimer, for real estate, in the office charged with the recording of deeds in the city or town where the real estate is situated; and, if probate proceedings have been commenced, also with the Clerk of the Probate Court in which those proceedings are instituted (§ 34-5-6(a)(2)).

☐ Serve a copy of this Disclaimer by delivering in hand or by certified mail to the last known address of each person or entity having legal title to or possession of the disclaimed property (§ 34-5-6(b)).

9. SIGNATURE AND RECORDING ACKNOWLEDGMENT

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

Signature of Disclaimant or Authorized Statutory Representative: ______________________________________

Printed Name: [________________________________] Capacity, if representative: [____________________]

ACKNOWLEDGMENT

Complete for a real-estate disclaimer presented for recording under R.I. Gen. Laws § 34-13-1(10), or when otherwise required for the transaction.

STATE OF RHODE ISLAND )
COUNTY OF [____________] )

In [____________], on this [____] day of [____________], 20[____], before me personally appeared [SIGNER FULL LEGAL NAME], known to me or proved to me, who acknowledged signing this instrument in the capacity stated above as a free act and deed.

______________________________________
Notary Public — State of Rhode Island
My commission expires: [__/__/____]

[NOTARY SEAL]

10. VERIFICATION / DECLARATION

I, [SIGNER FULL LEGAL NAME], declare under penalty of perjury under the laws of the State of Rhode Island that the foregoing facts are true and correct to the best of my knowledge. I sign as ☐ Disclaimant ☐ duly appointed guardian ☐ conservator ☐ legal representative of a deceased beneficiary's estate. If signing in a representative capacity, my authority is attached.

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 served (by hand delivery or certified mail) on the following persons or entities with legal title to or possession of the property under R.I. Gen. Laws § 34-5-6(b). For federal tax qualification, separately confirm receipt by a recipient named in 26 U.S.C. § 2518(b)(2) or a recipient permitted by Treas. Reg. § 25.2518-2(b)(2).

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 receipts or return of hand delivery)
☐ Recorded copy of the Disclaimer (city/town recorder of deeds), if real property is involved
☐ Filed copy from the Probate Court or Superior Court Clerk
☐ Court order extending the time to disclaim, if applicable (§ 34-5-5)
☐ Representative's guardianship, conservatorship, or estate appointment, if applicable
☐ Evidence of receipt by the federal recipient or timely mailing under Treas. Reg. § 25.2518-2(c)(2)

SOURCES AND REFERENCES

• R.I. Gen. Laws § 34-5-1 — Definitions and interests that may be disclaimed.
• R.I. Gen. Laws § 34-5-2 — Beneficiaries and interests subject to disclaimer.
• R.I. Gen. Laws § 34-5-4 — Written form and signature.
• R.I. Gen. Laws § 34-5-5 — State execution and filing deadlines.
• R.I. Gen. Laws § 34-5-6 — Filing office and service.
• R.I. Gen. Laws § 34-5-8 — Effect and passage.
• R.I. Gen. Laws § 34-5-9 — Waiver and bars.
• R.I. Gen. Laws § 34-13-1(10) — Recording instruments affecting land title.
• 26 U.S.C. § 2518 — Federal qualified-disclaimer conditions.
• 26 C.F.R. § 25.2518-2 — Federal qualified-disclaimer regulation.