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 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. Check Tennessee timing and filing requirements separately before use.

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 $[____________]).

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 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)).
• For federal qualified-disclaimer treatment, the refusal must be written, irrevocable, and unqualified. 26 U.S.C. § 2518(b)(1).
• For federal qualified-disclaimer treatment, the proper recipient must receive the writing within nine months after the later of the transfer creating the interest or the disclaimant reaching age 21. 26 U.S.C. § 2518(b)(2).
• Federal qualified-disclaimer treatment also requires nonacceptance of the interest or its benefits and passage without the disclaimant directing its destination. 26 U.S.C. § 2518(b)(3)–(4).

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, or powers disclaimed, and states the extent of the refusal. Confirm any additional Tennessee form requirements before use.

☐ For federal qualified-disclaimer treatment, this writing is received within nine (9) months after the later of the transfer creating this interest or the Disclaimant's 21st birthday (26 U.S.C. § 2518(b)(2)). Complete the applicable Tennessee delivery and filing steps in Section 8.

☐ The Disclaimant has NOT accepted the disclaimed interest or any of its benefits and has not exercised the power (26 U.S.C. § 2518(b)(3)).

☐ The disclaimed interest passes without any direction on the part of the Disclaimant (26 U.S.C. § 2518(b)(4)).

☐ 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 for purposes of 26 U.S.C. § 2518(b). The Disclaimant does not reserve a right to modify, withdraw, or rescind it after delivery or filing. 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

After confirming the applicable Tennessee delivery, filing, and recording rules, complete the applicable steps (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 recording is required for the real property interest.

☐ 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.

For federal qualified-disclaimer treatment, the proper recipient must receive the writing within the period described in Section 3. Confirm and meet any separate Tennessee delivery, filing, or recording deadline.

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