File No.
STATE OF NORTH CAROLINA

                                          County                                In The General Court Of Justice 
                                                                                 Superior Court Division
                                                                                              Before the Clerk
        IN THE MATTER OF THE ESTATE OF:
Name Of Decedent
                                                              RENUNCIATION OF RIGHT TO QUALIFY 
                                                              FOR LETTERS TESTAMENTARY 
                                                              OR LETTERS OF ADMINISTRATION
                                                                                              G.S. 28A-5-1, -2

To The Clerk Of Superior Court:

     1. The undersigned hereby renounces the right to qualify as executor of the estate of the above named decedent.

     2. The undersigned hereby renounces the right to administer the estate of the above named decedent and 
        respectfully asks that the following nominee be appointed administrator of the estate.
        Name Of Nominee

Date                                             Date 

Name Of Person Renouncing (Type Or Print)        Name Of Witness (Type Or Print)

Signature Of Person Renouncing                   Signature Of Witness

Date                                             Date 

Name Of Person Renouncing (Type Or Print)        Name Of Witness (Type Or Print)

Signature Of Person Renouncing                   Signature Of Witness

Date                                             Date 

Name Of Person Renouncing (Type Or Print)        Name Of Witness (Type Or Print)

Signature Of Person Renouncing                   Signature Of Witness

Date                                             Date 

Name Of Person Renouncing (Type Or Print)        Name Of Witness (Type Or Print)

Signature Of Person Renouncing                   Signature Of Witness

AOC-E-200, Rev. 7/06                             Original-File
© 2006 Administrative Office of the Courts