Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Virginia

Federal tax timing: Virginia's disclaimer chapter has no general nine-month deadline, but federal qualified-disclaimer treatment under 26 U.S.C. § 2518 generally requires delivery to an authorized recipient within nine months after the later of the transfer creating the interest or the disclaimant's 21st birthday. Treas. Reg. § 25.2518-2(c)(2) provides limited timely-mailing and weekend/holiday rules. Confirm the transfer date, recipient, and delivery method before signing.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

COMMONWEALTH OF VIRGINIA

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 an interest in or power over property has passed within the meaning of the Uniform Disclaimer of Property Interests Act (Va. Code ch. 26), namely a(n): ☐ heir ☐ devisee ☐ legatee ☐ beneficiary of a trust ☐ beneficiary under a beneficiary designation (annuity, insurance, POD account, security in beneficiary form, or employment-related benefit plan) ☐ surviving holder of jointly held property ☐ appointee, object, or taker in default under a power of appointment ☐ fiduciary ☐ 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, inter vivos, or testamentary trust
☐ Beneficiary designation (life insurance, retirement plan, annuity, POD/TOD account, or security registered in beneficiary form)
☐ Jointly held property (joint tenancy or tenancy by the entirety with right of survivorship)
☐ Power of appointment
☐ Other: [________________________________]

Extent of the disclaimer (Va. Code § 64.2-2603(E)):
☐ Full disclaimer — the Disclaimant disclaims the entire interest or power described above.
☐ Partial disclaimer — identify the precise portion disclaimed: [____________________]. For federal qualified-disclaimer treatment, check the applicable choice and Treas. Reg. § 25.2518-3:

☐ An entire separately created interest or independently severable property: [____________________].

☐ An undivided [____]% or [____]/[____] of every substantial right in the separate interest for its entire term, including converted property.

☐ A specific $[____________] amount from a bequest or gift; segregate the amount and attributable income from the retained portion, using fair market value on the disclaimer date or another basis fairly reflecting intervening value changes, under § 25.2518-3(c).

☐ Another state-law partial form (including a term of years or limited power); obtain tax review before treating it as federally qualified.

For a survivor's interest in jointly held property, determine the portion allowed by Va. Code § 64.2-2605(A) before filling in the extent of the disclaimer.

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, Va. Code § 64.2-2600 et seq. (ch. 26). If the federal requirements are met, it is also intended as a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. §§ 25.2518-2 and 25.2518-3.

• Va. Code § 64.2-2603(A) authorizes a person to disclaim, in whole or in part, any interest in or power over property, including a power of appointment, even if the creator imposed a spendthrift provision or similar restriction or a restriction on the right to disclaim.
• Va. Code § 64.2-2603(D) requires that, to be effective, a disclaimer be in writing or other record, declare the disclaimer, describe the interest or power disclaimed, be signed by the person making it, and be delivered or filed in the manner provided in § 64.2-2610.
• Va. Code § 64.2-2603(F) provides that a disclaimer becomes irrevocable when delivered or filed under § 64.2-2610 or when it becomes effective under §§ 64.2-2604 through 64.2-2609, whichever occurs later; and § 64.2-2603(G) provides that a disclaimer is not a transfer, assignment, or release.
• Va. Code § 64.2-2612 provides that if, as a result of a disclaimer, the disclaimed interest is treated under Title 26 of the U.S. Code as never having been transferred to the disclaimant, the disclaimer is effective as a disclaimer under this chapter.

4. THE DISCLAIMER

The Disclaimant hereby DISCLAIMS and RENOUNCES all (or, where a partial disclaimer is elected in Section 2, the precisely stated portion of) the interest or power described in Section 2 above. The irrevocability rule is stated in Section 7.

This Disclaimer is made freely and voluntarily. If effective under Virginia's disclaimer chapter, it is not a transfer, assignment, or release under Va. Code § 64.2-2603(G); a barred disclaimer may have a different effect under § 64.2-2611(F).

5. QUALIFIED-DISCLAIMER REPRESENTATIONS

The Disclaimant represents and certifies that:

☐ This Disclaimer is in writing or other record, declares the disclaimer, describes the interest or power disclaimed, and is signed by the Disclaimant or authorized legal representative, as applicable, under Va. Code § 64.2-2603(D) and Treas. Reg. § 25.2518-2(b).

☐ The Disclaimant has NOT accepted the disclaimed interest or any of its benefits, and has not assigned, conveyed, encumbered, pledged, or transferred the interest or contracted to do so (Treas. Reg. § 25.2518-2(d)).

☐ No written waiver, judicial sale, or other bar under Va. Code § 64.2-2611 applies to the interest disclaimed.

☐ 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)).

☐ For federal qualification, the interest passes to the decedent's spouse or another person as required by 26 U.S.C. § 2518(b)(4).

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

For an ordinary interest governed by Va. Code § 64.2-2604, the disclaimed interest first passes under any disclaimer provision in the instrument creating it. If none applies, the statutory default generally treats an individual disclaimant as having died just before the time of distribution. A disclaimer under this section takes effect when the creating instrument becomes irrevocable or, for intestacy, at the intestate's death. A survivor's disclaimer of jointly held property follows Va. Code § 64.2-2605 instead; other special interests or powers may follow §§ 64.2-2606 through 64.2-2609.

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

7. IRREVOCABILITY AND BINDING EFFECT

This Disclaimer becomes irrevocable when it is delivered or filed under Va. Code § 64.2-2610 or when it becomes effective under Va. Code §§ 64.2-2604 through 64.2-2609, whichever occurs later (Va. Code § 64.2-2603(F)). Before using it, check the bars in § 64.2-2611, including prior acceptance, a written waiver, transfer or pledge, or judicial sale of the interest.

8. DELIVERY, FILING, AND RECORDING

Pursuant to Va. Code § 64.2-2610, delivery may be effected by personal delivery, first-class mail, or any other method likely to result in its receipt. The Disclaimant shall (check all that apply):

☐ For an interest created under intestate succession or by will (other than an interest in a testamentary trust): deliver this Disclaimer to the personal representative of the Decedent's estate; or, if no personal representative is then serving, file it with a court having jurisdiction to appoint the personal representative (Va. Code § 64.2-2610(C)).

☐ For an interest in a testamentary or inter vivos trust: deliver this Disclaimer to the trustee then serving (or as otherwise provided in § 64.2-2610(D)–(E)).

☐ For an interest created by a beneficiary designation: deliver this Disclaimer to the person obligated to distribute the interest (or to the person making the designation if not yet irrevocable) (Va. Code § 64.2-2610(F)–(G)).

☐ For jointly held property: deliver this Disclaimer to the person to whom the disclaimed interest passes (Va. Code § 64.2-2610(H)).

☐ Record a copy of this Disclaimer in the office of the Clerk of the Circuit Court for [____________], Virginia, where the real property is located, if an instrument transferring title to real property is disclaimed (Va. Code § 64.2-2613). Failure to record does not affect validity as between the Disclaimant and persons to whom the interest passes.

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[____].

Signer: ☐ Disclaimant personally ☐ Authorized legal representative or fiduciary

Signature: ______________________________________

Printed Name and capacity: [________________________________]

If signing for another, identify and attach authority: [________________________________]

ACKNOWLEDGMENT

COMMONWEALTH OF VIRGINIA )
CITY/COUNTY OF [____________] )

The foregoing instrument was acknowledged before me this [____] day of [____________], 20[____], by [SIGNER NAME], in the capacity stated above.

______________________________________
Notary Public
Registration No.: [____________]
My commission expires: [__/__/____]

[NOTARY SEAL]

10. VERIFICATION / DECLARATION

I, [SIGNER NAME], confirm that the factual statements in this Disclaimer are true to the best of my knowledge, that the Disclaimant has not accepted the disclaimed interest or its benefits, and that I sign voluntarily in the capacity stated above.

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 (by personal delivery, first-class mail, or another method likely to result in its receipt, including 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 (Clerk of the Circuit Court), if real property is involved
☐ File-stamped copy from the Circuit Court, if filed there

SOURCES AND REFERENCES

• Uniform Disclaimer of Property Interests Act, Va. Code ch. 26 (§§ 64.2-2600 to 64.2-2614) — https://law.lis.virginia.gov/vacodefull/title64.2/chapter26/
• Va. Code §§ 64.2-2603 through 64.2-2613 — https://law.lis.virginia.gov/vacodefull/title64.2/chapter26/
• 26 U.S.C. § 2518 — https://uscode.house.gov/us/usc/119-136/t26/s2518/
• Treas. Reg. §§ 25.2518-2 and 25.2518-3 — https://www.govinfo.gov/bulkdata/ECFR/title-26/ECFR-title26.xml