Disclaimer and Renunciation of Interest (Qualified Disclaimer) — Wyoming

TIMING — IRC § 2518 (9-MONTH DEADLINE): To qualify as a federal "qualified disclaimer," this writing must be signed and delivered 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. Wyo. Stat. Ann. § 2-1-403(a)(ii) independently requires the writing to be received by the transferor (or the transferor's legal representative or holder of legal title) within nine (9) months of the later of the transfer or the disclaimant turning 21. Verify the deadline with counsel before signing.

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 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 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 — 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 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.

4. THE DISCLAIMER

The Disclaimant, intending to be legally bound, hereby makes a WRITTEN, 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, and interest of every kind — whether vested or contingent, present or future, legal or equitable — in and to the property and interest 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 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 is being 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 the interest is made (or the date of the Decedent's death), 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 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 (Wyo. Stat. Ann. § 2-1-403(a)(iii); Treas. Reg. § 25.2518-2(d)).

☐ 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); Treas. Reg. § 25.2518-2(e)).

☐ 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

Under Wyo. Stat. Ann. § 2-1-404, unless the deed of gift or will expressly provides otherwise:

• the disclaimed interest reverts to the transferor if he is living on the date of disclaimer; or
• if the transferor died testate before the disclaimer, the interest passes under the residuary clause of the transferor's will (and, if the Disclaimant is a residuary beneficiary, as though the Disclaimant did not survive the transferor); or
• if the transferor died intestate before the disclaimer, the interest passes under the laws of descent and distribution as though the Disclaimant did not survive the transferor; and
• if the interest would have passed by right of survivorship, it passes as though the Disclaimant was not a survivor.

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

7. IRREVOCABILITY AND BINDING EFFECT

This Disclaimer is an irrevocable and unqualified refusal to accept the interest (Wyo. Stat. Ann. § 2-1-403(a)(i)) and may not be modified, withdrawn, or rescinded once delivered. It is binding upon the Disclaimant and all persons claiming through or under the Disclaimant.

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.

☐ File a copy of this Disclaimer with the District Court of [____________] County, Wyoming, in which probate proceedings for the Decedent's estate have been or may be commenced.

☐ Record a copy of this Disclaimer in the Office of the County Clerk of [____________] County, Wyoming, where the real property is located, if real property or an interest in real property is disclaimed, to give record notice.

9. SIGNATURE, ACKNOWLEDGMENT, AND NOTARIZATION

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

Disclaimant Signature: ______________________________________

Printed Name: [________________________________]

ACKNOWLEDGMENT

STATE OF WYOMING )
COUNTY OF [____________] )

The foregoing instrument was acknowledged before me this [____] day of [____________], 20[____], by [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 as his/her free and voluntary act.

Witness my hand and official seal.

______________________________________
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 Wyoming that the foregoing is true and correct, that I have not accepted the disclaimed interest or any benefit thereof, 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, 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 the recorded Disclaimer (County Clerk), if real property is involved
☐ File-stamped copy from the District Court (probate proceeding)

SOURCES AND REFERENCES

• Wyo. Stat. Ann. § 2-1-401 (Right to disclaim) — https://law.justia.com/codes/wyoming/title-2/chapter-1/article-4/section-2-1-401/
• Wyo. Stat. Ann. § 2-1-403 (Qualification; effective date) — https://law.justia.com/codes/wyoming/title-2/chapter-1/article-4/section-2-1-403/
• Wyo. Stat. Ann. § 2-1-404 (Disposition of disclaimed interest) — https://law.justia.com/codes/wyoming/title-2/chapter-1/article-4/section-2-1-404/
• 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