Filing Of Disclaimer For Record {447PC}

STATE OF SOUTH CAROLINA COUNTY OF: ____________________________ IN THE MATTER OF: ________________________________________ (Decedent/Incapacitated) ) ) ) ) ) ) ) IN THE PROBATE COURT FILING OF A DISCLAIMER FOR RECORD* CASE NUMBER: ________________________________ NOTE THIS DOCUMENT IS NOT A DISCLAIMER; THE DISCLAIMER MUST BE ATTACHED 1. Disclaimant information: Full Name: _______________________________________________________________________ Address: ________________________________________________________________________ ________________________________________________________________________ _________________________________________________________________________ Transferor's information: Full Name: _______________________________________________________________________ Address: ________________________________________________________________________ ________________________________________________________________________ _________________________________________________________________________ 2. Filing the Disclaimer in this county is proper because: a. It relates to a Decedent domiciled in this county at date of death (attach death certificate if not previously filed). b. It relates to Guardianship or Conservatorship action ongoing in this county; Case Number(s): _______________. c. After due diligence the undersigned was unable to locate the Transferor for delivery of the attached Disclaimer but has determined that this Court has jurisdiction to accept the Disclaimer for recording due to: _________________________________________________________________________________________. Note: The Probate Court is not the proper Court for filing of a disclaimer for record related to real property unless it is related to one of the above matters in (a) or (b). 3. Attached is/are the Disclaimer(s) executed:_____________________________________________ Pursuant to SCPC 62-2-801, the undersigned delivers the Disclaimer of the above-referenced Disclaimant to the office of the Probate Court of the above County. Executed this __________ day of __________________________, 20_______. Signature: Name: Address: Telephone (Work): (Home): (Cell): Email: Relationship to Decedent/Estate or Incapacitated Person : _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ * FILING A DISCLAIMER PURSUANT TO SCPC 62-2-801 DOES NOT IN ITSELF CONSTITUTE A QUALIFIED DISCLAIMER IN ACCORDANCE WITH INTERNAL REVENUE CODE §2518. Form 447PC (1/2014) 62-2-801 American LegalNet, Inc. www.FormsWorkFlow.com