Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Tennessee

TIMING — IRC § 2518 (9-MONTH DEADLINE): To qualify as a federal "qualified disclaimer," this writing must be signed and delivered/filed 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. Tenn. Code Ann. § 31-1-103(b)(2) imposes the same nine-month deadline under state law. Verify the deadline with counsel before signing.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

STATE OF TENNESSEE

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 property, powers, or an interest in property has devolved within the meaning of Tenn. Code Ann. § 31-1-103(a), namely a(n): ☐ donee of a gift (outright or in trust) ☐ recipient of property from a decedent's estate ☐ recipient of property on the exercise of a power of appointment ☐ recipient of property resulting from another person's disclaimer ☐ recipient of property by another gratuitous transfer ☐ fiduciary holding powers as a fiduciary ☐ beneficiary designated in a POD account, insurance policy, IRA, annuity, retirement plan, or other deferred-compensation arrangement ☐ 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 (Tenn. Code Ann. § 31-2-104 et seq.)
☐ Revocable or testamentary trust
☐ Beneficiary designation (life insurance, IRA, retirement plan, annuity, POD/TOD account, or security registered in beneficiary form)
☐ Joint tenancy / survivorship arrangement
☐ Power of appointment
☐ Fiduciary power held by the Disclaimant
☐ 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 fractional, percentage, or pecuniary 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 Tenn. Code Ann. § 31-1-103 and is intended to constitute a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2.

• Tenn. Code Ann. § 31-1-103(a) authorizes a person to whom property, powers, or an interest devolves to disclaim all or part of it, notwithstanding any spendthrift provision or similar restriction (§ 31-1-103(e)).
• Tenn. Code Ann. § 31-1-103(b)(1) requires that the disclaimer (A) describe the property, interest, or powers disclaimed; (B) be signed by the disclaimant or the disclaimant's representative; and (C) declare the disclaimer and its extent — and that the refusal be irrevocable and unqualified.
• Tenn. Code Ann. § 31-1-103(b)(2) requires that the writing be received by the transferor, the transferor's legal representative, or the holder of legal title (and, for realty, filed in the county register's office, and, for an interest in a decedent's estate, with the court) not later than nine (9) months after the later of the date of the transfer or the date the disclaimant attains age 21.
• Tenn. Code Ann. § 31-1-103(b)(3)–(4) require that the Disclaimant has not accepted the interest or its benefits and that, as a result of the refusal, the interest passes without direction.

4. THE DISCLAIMER

The Disclaimant, intending to be legally bound, hereby makes an IRREVOCABLE and UNQUALIFIED REFUSAL to accept, and hereby 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, interest, and fiduciary power of every kind — whether vested or contingent, present or future, legal or equitable — in and to the property, interest, and powers 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 and signed by the Disclaimant (or the Disclaimant's representative), describes the property/interest/powers disclaimed, and declares the disclaimer and its extent, as required by Tenn. Code Ann. § 31-1-103(b)(1) and Treas. Reg. § 25.2518-2(b).

☐ This Disclaimer is being delivered and filed within nine (9) months after the later of (a) the date of the Decedent's death or the effective date of the transfer creating the interest, or (b) the date the Disclaimant attained age 21 (Tenn. Code Ann. § 31-1-103(b)(2); 26 U.S.C. § 2518(b)(2)).

☐ The Disclaimant has NOT accepted the disclaimed interest or any of its benefits and has not exercised the power (Tenn. Code Ann. § 31-1-103(b)(3), (d); Treas. Reg. § 25.2518-2(d)).

☐ The disclaimed interest passes without any direction on the part of the Disclaimant (Tenn. Code Ann. § 31-1-103(b)(4); 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 predeceased the Decedent (or donee of the power), as provided by Tenn. Code Ann. § 31-1-103(c).

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

Under Tenn. Code Ann. § 31-1-103(c), unless the decedent has otherwise indicated by will, the disclaimed interest passes to those persons, including those who would take under Tenn. Code Ann. § 32-3-105, as if the Disclaimant had predeceased the Decedent. Unless the donor of a gift or the creator of a power has otherwise indicated, a disclaimed interest passes to the donor or creator of the power. A disclaimed fiduciary power is either exercisable by another fiduciary or void. In every case the disclaimer relates back for all purposes to the date of the Decedent's death, the date of the gift, or the date of death of the donee of a power, as applicable.

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

7. IRREVOCABILITY AND BINDING EFFECT

This Disclaimer is an irrevocable and unqualified refusal (Tenn. Code Ann. § 31-1-103(b)) and may not be modified, withdrawn, or rescinded once delivered or filed. It is binding upon the Disclaimant and all persons claiming through or under the Disclaimant. If made by a fiduciary, this Disclaimer is binding on any successor fiduciary (Tenn. Code Ann. § 31-1-103(a)).

8. DELIVERY, FILING, AND RECORDING

Pursuant to Tenn. Code Ann. § 31-1-103(b)(2), the Disclaimant shall (check all that apply):

☐ Deliver this Disclaimer so that it is received by the transferor of the interest, the transferor's legal representative, or the holder of legal title to the property to which the interest relates.

☐ File this Disclaimer with the court in which the Decedent's estate proceedings are or would be pending ([____________] County Probate/Chancery Court, Tennessee), if the disclaimer involves an interest in a decedent's estate.

☐ File / record this Disclaimer in the office of the County Register of [____________] County, Tennessee, where the real property is located, if the subject of the disclaimer is realty (Tenn. Code Ann. § 31-1-103(b)(2)(A)).

☐ Deliver a copy, in person or by registered or certified mail, return receipt requested, to the personal representative, trustee, or other fiduciary, and to any affected person.

All delivery, filing, and recording must occur within the nine-month period described in Section 1 and Tenn. Code Ann. § 31-1-103(b)(2).

9. SIGNATURE, ACKNOWLEDGMENT, AND NOTARIZATION

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

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

ACKNOWLEDGMENT

STATE OF TENNESSEE )
COUNTY OF [____________] )

Before me, the undersigned Notary Public in and for said county and state, personally appeared [DISCLAIMANT FULL LEGAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, who acknowledged that he/she executed the same voluntarily for the purposes therein contained.

Witness my hand and official seal this [____] day of [____________], 20[____].

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

[NOTARY SEAL]

10. VERIFICATION / DECLARATION

I, [DISCLAIMANT FULL LEGAL NAME], declare under penalty of perjury under the laws of the State of Tennessee that the foregoing is true and correct, that I have not accepted the disclaimed interest or any benefit thereof and have not exercised the disclaimed power, 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) 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 Register), if real property is involved
☐ File-stamped copy from the Probate/Chancery Court (estate proceeding)

SOURCES AND REFERENCES

• Tenn. Code Ann. § 31-1-103 (Disclaimer) — https://law.justia.com/codes/tennessee/title-31/chapter-1/section-31-1-103/
• Tenn. Code Ann. § 32-3-105 (Anti-lapse) — https://law.justia.com/codes/tennessee/title-32/chapter-3/section-32-3-105/
• 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