This form is a Renunciation and Disclaimer of Property acquired by the beneficiary through intestate succession. The decedent died intestate and the beneficiary gained an interest in the described property of the decedent. However, pursuant to the Indiana Code, Title 29, Chapter 2, the beneficiary wishes to disclaim a portion of or the entire interest in the property. The beneficiary attests that the disclaimer will be filed no later than nine months after the death of the decedent. The form also contains a state specific acknowledgment and a certificate to verify delivery.