Free ______________________County, Colorado District Court - Colorado

District Court Denver Probate Court ___________________________________ County, Colorado Court Address: ___________________________________________ In the Interests of: ___________________________________________ Minor Attorney or Party Without Attorney (Name and Address): ___________________________________________ ___________________________________________ Phone Number:_________________ E-mail: __________________ FAX Number:___________________ Atty. Reg. #.: ______________ COURT USE ONLY Case Number:__________________

Division______ Courtroom _______

VERIFIED CONSENT OR NOMINATION OF MINOR
I, _________________________________ (full name of minor) am 12 years of age or older and I: Consent to the appointment of ________________________________ (full name) as my guardian(s) pursuant to §15-14-203, C.R.S. Do not consent to the appointment of ________________________________ (full name) as my guardian(s) pursuant to §15-14-203, C.R.S. Nominate __________________________________ (full name), who is 21 years of age or older, as my guardian(s) conservator(s) pursuant to §15-14-206, C.R.S. and/or 15-14-413,(1)(b), C.R.S. (Optional)

VERIFICATION AND ACKNOWLEDGMENT
I swear/affirm under oath that I have read the foregoing Consent or Nomination by Minor and that the statements set forth therein are true and correct to the best of my knowledge.

Date: __________________________

___________________________________________
Signature of Minor

_____________________________________________ Address _____________________________________________ City State Zip Code _____________________________________________ Daytime Phone Number

Subscribed and affirmed, or sworn to before me in the County of _________________________, State of ________________, this ___________ day of _______________, 20 _______. My Commission Expires: ____________________ _____________________________________ Notary Public/Clerk

JDF 826 11/07

VERIFIED CONSENT OR NOMINIATION OF MINOR