WAIVER OF QUALIFICATION VA. CODE §§ 64.2-500, 64.2-502 Court File No. ............................................................................. TO THE CLERK: ............................................................................................................................................................................................................. ..................................................................................................................... NAME OF DECEDENT Virginia, Circuit Court ..................................................................................................................... DATE OF DEATH 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) ______________________________________________________________ ______________________________________________________________ 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 ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... [ ] City [ ] County of ........................................................................... State/Commonwealth of ........................................................................ .............. Acknowledged, subscribed and sworn to before me this ...................... day of .............................................................................. , 20 by NAME(S) AND TITLE(S) OR POSITION ....................................................................................................................................................................................................................................................... _______________________________________________ Notary Public My commission expires Registration No. __________________________________________________ ............................................................................ ........................................................................................... , Clerk, by _____________________________________________ Deputy Clerk FORM CC-1608 MASTER 10/12 American LegalNet, Inc. www.FormsWorkFlow.com