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This form is a Renunciation and Disclaimer of Life Insurance and/or Annuity Contract proceeds where the beneficiary has an interest in life insurance and/or annuity contract proceeds due to the death of the decedent, but, pursuant to the Oregon Uniform Disclaimer of Property Interest Act, Oregon Revised Statutes, Chapter 245, has chosen to disclaim his/her interest in the proceeds. The form also contains a state specific acknowledgment and a certificate to verify delivery.
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