WAIVER OF QUALIFICATION Court File No. .................................................................................
VA. CODE §§ 64.2-500, 64.2-502
TO THE CLERK:
................................................................................................................................................................................................................... Virginia, Circuit Court
......................................................................................................................... .........................................................................................................................
NAME OF DECEDENT DATE OF DEATH
[ ] City [ ] County of ............................................................................. State/Commonwealth of ............................................................................
Acknowledged, subscribed and sworn to before me this ....................... day of ................................................................................., 20 ...............
by ................................................................................................................................................................................................................................................................
PRINT NAME OF SIGNATORY
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[ ] CLERK [ ] DEPUTY CLERK
[ ] NOTARY PUBLIC My commission expires ...............................................
Registration No. ............................................................
1. I/We, the executor(s) appointed by the decedent's will,
[ ] I refuse the executorship
[ ] I refuse the executorship in favor of the co-executor(s)
SIGNATURE OF EXECUTOR(S)
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2. [ ] I/We, residual or substantial legatee(s) (persons to whom decedent willed personal property), or
[ ] I/We, distributees of the intestate decedent's estate (relatives under Va. Code § 64.2-201; see also § 64.2-200),
decline to qualify on the estate and request appointment of
..................................................................................................................................................................................................................................................................
NAME AND ADDRESS OF PERSON NOMINATED FOR APPOINTMENT
[ ] as administrator, c.t.a. (if decedent left a will) or
[ ] as administrator (if decedent did not leave a will)
SIGNATURE(S), LEGATEE(S)/DISTRIBUTEE(S) RELATIONSHIP TO DECEDENT
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FORM CC-1608 MASTER 11/16
