Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Wyoming

Before you use this: Identify the transfer that created this particular interest and its recipient before calculating the deadline. Federal tax law and Wyoming law each use the later of that transfer or the disclaimant's 21st birthday; Wyoming § 2-1-403(a)(ii) requires receipt by its listed recipient within nine months. Federal Treas. Reg. § 25.2518-2(c)(2) has limited timely-mailing and weekend/holiday rules; do not assume those extend Wyoming's separate receipt deadline.

DISCLAIMER AND RENUNCIATION OF INTEREST (QUALIFIED DISCLAIMER)

STATE OF WYOMING

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
8. Delivery, Filing, and Recording
9. Signature, Acknowledgment, and Notarization
10. Certificate of Delivery / Service
11. Attachments Checklist

1. DISCLAIMANT INFORMATION

The undersigned (the "Disclaimant") is a person who, but for this Disclaimer, would receive an interest in property under Wyo. Stat. Ann. § 2-1-401, namely a(n): ☐ heir ☐ next of kin ☐ devisee ☐ legatee ☐ donee under a gift ☐ surviving joint tenant (right of survivorship) ☐ beneficiary under a beneficiary designation ☐ appointee under a power of appointment ☐ fiduciary (acting in a personal or representative capacity, where authorized) ☐ 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 / laws of descent and distribution (Wyo. Stat. Ann. Title 2, ch. 4)
☐ Gift (deed of gift)
☐ Revocable or testamentary trust
☐ Beneficiary designation (life insurance, retirement plan, annuity, POD/TOD account, or security registered in beneficiary form)
☐ Joint tenancy with right of survivorship
☐ Power of appointment
☐ Other: [________________________________]

Extent of the disclaimer:
☐ Full disclaimer — the Disclaimant disclaims the entire interest described above.
☐ Partial disclaimer of an undivided portion — the Disclaimant disclaims an undivided [____]% of every substantial right in the separate interest described above, for its entire term and in property into which it is converted (26 U.S.C. § 2518(c)(1); Treas. Reg. § 25.2518-3(b)).

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

3. STATUTORY AUTHORITY

This Disclaimer is made under the Wyoming disclaimer statutes, Wyo. Stat. Ann. §§ 2-1-401 through 2-1-405, and is intended to constitute a qualified disclaimer under 26 U.S.C. § 2518 and Treas. Reg. § 25.2518-2.

• Wyo. Stat. Ann. § 2-1-401(a) provides that any person may disclaim any interest in property which, without a disclaimer, he would receive by gift, bequest, devise, inheritance, beneficiary designation, the exercise of a power of appointment, or by right of survivorship.
• Wyo. Stat. Ann. § 2-1-403(a) sets the requirements to qualify as a disclaimer: (i) a written, irrevocable, and unqualified refusal to accept the interest; (ii) receipt of the writing by the transferor, the transferor's legal representative, or the holder of legal title within nine (9) months after the later of the transfer or the disclaimant attaining age 21; (iii) no acceptance of the interest or its benefits; and (iv) passing of the interest without any direction by the disclaimant, either to the decedent's spouse or to a person other than the disclaimant.
• Wyo. Stat. Ann. § 2-1-404 governs the disposition of the disclaimed interest.
• A fiduciary's representative-capacity disclaimer remains subject to the restrictions in § 2-1-401(b). An agent under a power of attorney must have express disclaimer authority in that instrument. A guardian of property for a person under 21 or an incompetent person needs the court showing and approval described in § 2-1-405.

4. THE DISCLAIMER

The Disclaimant hereby makes a WRITTEN, IRREVOCABLE, and UNQUALIFIED REFUSAL to accept the interest identified in Section 2. If the full-disclaimer box is selected, the Disclaimant disclaims the entire identified interest. If the partial-disclaimer box is selected, the Disclaimant disclaims only the identified undivided percentage of that interest. The Disclaimant gives no direction concerning the person who will receive the disclaimed interest.

The Disclaimant signs voluntarily and identifies the interest being refused above.

5. QUALIFIED-DISCLAIMER REPRESENTATIONS

The Disclaimant represents and certifies that:

☐ This Disclaimer is a written, irrevocable, and unqualified refusal to accept the interest, as required by Wyo. Stat. Ann. § 2-1-403(a)(i) and Treas. Reg. § 25.2518-2(b).

☐ This writing will be received by the transferor, the transferor's legal representative, or the holder of legal title to the property within nine (9) months after the later of (a) the day the transfer creating this particular interest was made, or (b) the day the Disclaimant attained age 21 (Wyo. Stat. Ann. § 2-1-403(a)(ii); 26 U.S.C. § 2518(b)(2)). The identified transfer date is [__/__/____], based on [GOVERNING INSTRUMENT OR EVENT: ________________________________________________].

☐ The Disclaimant has NOT accepted the disclaimed interest or any of its benefits (Wyo. Stat. Ann. § 2-1-403(a)(iii); 26 U.S.C. § 2518(b)(3)).

☐ As a result of this refusal, the interest passes without any direction on the part of the Disclaimant, and passes either to the spouse of the Decedent or to a person other than the Disclaimant (Wyo. Stat. Ann. § 2-1-403(a)(iv); 26 U.S.C. § 2518(b)(4)).

☐ This Disclaimer is intended to satisfy the requirements of a qualified disclaimer under 26 U.S.C. § 2518.

6. EFFECT AND PASSING OF THE DISCLAIMED INTEREST

The Disclaimant does not direct who receives the disclaimed interest. Its destination must be determined under the governing transfer instrument and applicable law. The instrument creating this interest is [TITLE AND DATE: ________________________________________________]; the person administering or holding it is [NAME AND CAPACITY: ________________________________________________].

For an interest governed by a deed of gift or will, Wyo. Stat. Ann. § 2-1-404(a) gives default rules unless that deed or will expressly provides otherwise: the interest reverts to a living transferor, or, if the transferor died before the disclaimer, passes under the will's residuary clause. A residuary disclaimant is treated as not surviving the transferor for that default. If the transferor died intestate, § 2-1-404(b) applies descent and distribution as though the Disclaimant did not survive. If the interest would have passed by right of survivorship, § 2-1-404(c) treats the Disclaimant as not a survivor. For an interest created by a trust, beneficiary designation, or power of appointment, read that instrument's successor-beneficiary terms and applicable law before determining the taker; the will defaults are not a substitute for those terms.

7. IRREVOCABILITY

This Disclaimer is an irrevocable and unqualified refusal to accept the identified interest under Wyo. Stat. Ann. §§ 2-1-402(a)(ii) and 2-1-403(a)(i).

8. DELIVERY, FILING, AND RECORDING

Pursuant to Wyo. Stat. Ann. § 2-1-403(a)(ii), the Disclaimant shall ensure this writing is received within the nine-month period by the appropriate person (check all that apply):

☐ Deliver this Disclaimer to the transferor of the interest, in person or by registered or certified mail, return receipt requested.

☐ Deliver this Disclaimer to the transferor's legal representative (personal representative or other fiduciary of the Decedent), in person or by registered or certified mail.

☐ Deliver this Disclaimer to the holder of legal title to the property to which the interest relates (e.g., trustee, plan administrator, or financial institution), in person or by registered or certified mail.

Optional court filing or land-record recording, if applicable to the proceeding or property, is separate from the timely receipt required by § 2-1-403(a)(ii). Record any filing or recording here: [COURT OR COUNTY CLERK, DATE, DOCUMENT NUMBER, OR “NONE”: ________________________________________________].

9. SIGNATURE, ACKNOWLEDGMENT, AND NOTARIZATION

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

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

OPTIONAL NOTARIAL ACKNOWLEDGMENT

STATE OF WYOMING )
COUNTY OF [____________] )

The foregoing instrument was acknowledged before me this [____] day of [____________], 20[____], by [DISCLAIMANT FULL LEGAL NAME], whose identity was established by [METHOD: ________________________________], and who acknowledged signing this instrument.

Witness my hand and official seal.

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

[NOTARY SEAL]

10. 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: [________________________________]

11. ATTACHMENTS CHECKLIST

☐ Copy of the Last Will and Testament, deed of gift, 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 receipt / delivery (registered or certified mail return receipts)
☐ Copy of any optional recording or court filing, if made

SOURCES AND REFERENCES

• Wyoming Legislature — current Title 2, §§ 2-1-401–405
• U.S. Code — 26 U.S.C. § 2518
• eCFR — 26 C.F.R. § 25.2518-2
• eCFR — 26 C.F.R. § 25.2518-3