Free ______________________County, Colorado District Court - Colorado

District Court Denver Probate Court __________________________________ County, Colorado Court Address:
_________________________________________

In the Interests of: In the Matter of the Estate of: _______________________________________ Attorney or Party Without Attorney (Name and Address):
___________________________________________ ___________________________________________

COURT USE ONLY Case Number:_________________

Phone Number:_________________ E-mail: __________________ FAX Number:___________________ Atty. Reg. #: ______________

Division_____ Courtroom ________

RECEIPT AND RELEASE
Received from _________________________________________, partial full payment and satisfaction of the following: Personal Representative Conservator

the devise to me in the will under article(s) _________________________________________________. my ________ share of the estate in the will under article(s) __________________________________. my ________ share of the estate as heir. my distribution from the conservatorship case. Cash in the amount of $ __________________. Tangible personal property described as: * ____________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ The following securities: * ____________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Other (describe): * _______________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ I grant a partial release and satisfaction to the fiduciary of the estate as to the above partial distribution. I grant a full and final release and satisfaction to the estate and to the fiduciary and his or her successors for any liability in connection with my interest in the estate.

Date: _________________________________

______________________________________ Signature ______________________________________ (Type or print name below)

* Attach additional sheets as necessary.

JDF 731

3/08

RECEIPT AND RELEASE