Free District Court Denver Probate Court - Colorado

District Court Denver Probate Court __________________________________ County, Colorado Court Address: _______________________________________ In the Interests of: _______________________________________ Protected Person Attorney or Party Without Attorney (Name and Address): ______________________________________ ______________________________________ COURT USE ONLY Case Number: __________________

Phone Number:_________________ E-mail: ___________________ FAX Number: __________________ Atty. Reg. #: ________________ Division _______ Courtroom _______

FOREIGN CONSERVATOR'S SWORN STATEMENT
I, ____________________________________, as the foreign conservator (§15-14-433, C.R.S.), state that a conservator has not been appointed in this state and no petition in a protective proceeding is pending in Colorado for the protected person. I hereby file with this Court the following documents: Certified, exemplified, or authenticated copies of the foreign court's order appointing me as conservator; Certified, exemplified, or authenticated copies of the foreign court's letters or other documents evidencing or affecting my authority to act as conservator; Certified, exemplified, or authenticated copies of any bonds filed with the appointing foreign court; Other: ______________________________________________________________________________.

As the foreign conservator and being sworn, I verify that the facts set forth in this statement are true to the best of my knowledge, information, and belief.

Date: ___________________________

_____________________________________________ Signature of Foreign Conservator _____________________________________________ Street _____________________________________________ 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/Deputy Clerk

JDF 891

11/07

FOREIGN CONSERVATOR'S SWORN STATEMENT