“I, A. B., surviving wife (or husband) of C. D., deceased, hereby renounce and disclaim any and all benefits under the will of C. D., and elect to take from the estate of C. D. only the property and benefits which (because of this election) will accrue to me under Section 33 of Act No. 140, approved February 23, 1949, as amended
DATED: . . . . . ., 20. . . . . .
SIGNED: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .” (ACKNOWLEDGMENT)