Free ______________________County, Colorado District Court - Colorado

District Court Denver Probate Court ____________________________________ County, Colorado Court Address: _________________________________________________ In the Matter of the Estate of: ________________________________________________ Deceased Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:_________________

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

Division ______ Courtroom ________

APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR PURSUANT TO §15-12-614, C.R.S.
The Applicant, an interested person pursuant to §15-10-201(27), C.R.S., makes the following statements:

1. Information about the Applicant: Name: Street Address: Mailing Address, if different: City: Email Address: State: Zip Code: Work Phone #: Home Phone #: Relationship to Decedent

2. The Decedent died on resided in the City of

(date) at the age of County of

years. The Decedent was domiciled or , the State of .

3. Venue for this proceeding is proper in this county because the Decedent: had his or her domicile or residence in this county on the date of death. did not have his or her domicile or residence in Colorado, but had property located in this county on the date of death.

4. This Application is filed within the time period permitted by law. Three years or less have passed since the Decedent's death, or circumstances described in §15-12-108, C.R.S. authorize tardy probate or appointment.

5. The Applicant: has not received a Demand for Notice of Filings or Orders and is unaware of any Demand for Notice of Filings or Orders concerning Decedent. has received or is aware of a Demand for Notice of Filings or Orders concerning decedent. See attached Demand for Notice of Filings or Orders or explanation.

6.

No court has appointed a Personal Representative and no such appointment proceeding is pending in this state or elsewhere.
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A court has appointed a Personal Representative or an appointment proceeding is pending in the State of . (Attach a statement explaining the circumstances and indicating the name and address of the Personal Representative. Attach a certified copy of the appointing document if the appointment has been finalized.)

7. or

Except as may be disclosed in an attached explanation and after the exercise of reasonable diligence, the Applicant is unaware of any unrevoked Will relating to property in Colorado. The date of the Decedent's last Will is . . The dates of all codicils are The Will and any codicils are referred to as the Will. The Applicant believes that it is the Decedent's last Will and that it was validly executed. Except as may be disclosed in an attached explanation and after the exercise of reasonable diligence, the Applicant is unaware of any instrument revoking the Will and is unaware of any prior Wills relating to property in Colorado that have not been expressly revoked by a later instrument. The original Will was deposited with this Court before the Decedent's death. (§15-11-515, C.R.S.) has been delivered to this Court since the Decedent's death. (§15-11-516, C.R.S.) is filed with this Application. An e-filed copy of the Will is filed with this Application. The original document will be delivered to the Court forthwith or has been delivered to the Court. The Will has been probated in the State of . Authenticated copies of the Will and of the statement probating it are filed with this Application. (§15-12-402, C.R.S.)

8. Decedent's marital and family status: a) Did a spouse survive the Decedent? If the answer to a) is Yes, also answer the following questions: b) Did the Decedent have a surviving parent? c) Did the Decedent have surviving children or other descendants? If the answer to c) is Yes, also answer the following questions: d) Does the Decedent's surviving spouse have surviving descendants who are not descendants of the Decedent? e) Are all of the Decedent's surviving descendants also descendants of the surviving spouse? If the answer to e) is No, also answer the following question: f) Are any of the Decedent's children minors?

Yes

No

Yes Yes

No No

Yes Yes

No No

Yes

No

9. List names and addresses of Decedent's spouse, children, other heirs and devisees are as follows: If a guardian or conservator has been appointed for one of the persons listed below, also provide the name and address of the guardian or conservator. If a minor child is listed, list the child's parent(s), guardian or conservator. If a spouse or child has predeceased the Decedent, include the date of death.

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APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR

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Name

Address (or date of death)

Age, only if Minor

Relationship (e.g. spouse, child, brother, guardian for spouse, etc.)

10. Applicant requests appointment of a Special Administrator: to protect the Decedent's estate prior to the appointment of a Personal Representative for the following reasons:

because a prior appointment has been terminated as provided in §15-12-614(1)(a), C.R.S. to address claims as a Public Administrator. (§15-12-621(9), C.R.S.)

11. or

Applicant is 21 years of age or older and nominates himself/herself to be appointed as Special Administrator. Applicant nominates the following person be appointed as Special Administrator. Name: Street Address: Mailing Address, if different: City: Email Address: State: Zip Code: Home Phone #: Work Phone #: The Nominee is 21 years of age or older.

The Nominee has priority for appointment because of: statutory priority (§15-12-203, 15-12-615 and 15-12-621(9), C.R.S.) reasons stated in the attached explanation.

Persons with prior or equal rights to appointment are as follows:

They have each renounced their rights to appointment or have been given notice of these proceedings. Any required renouncements accompany this Application. No notice has been given because an emergency exists and appointment should be made forthwith.

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12. Applicant states the following regarding the Decedent's estate. Estimated value of real estate Estimated value of personal property Annual income expected from all sources $ $ $

TOTAL $
13. Bond in the amount of $ is requested. (§15-12-603(1)(a), C.R.S.)

The Applicant requests that the Registrar informally appoint the Nominee as Special Administrator to serve with bond and that Letters of Special Administration be issued.

VERIFICATION AND ACKNOWLEDGMENT
I (Applicant) verify that the facts set forth in this document are true as far as I know or am informed. I understand that penalties for perjury follow deliberate falsification of the facts stated herein. (§15-10-310, C.R.S.)

____________________________________________ Signature of Applicant Date The foregoing instrument was acknowledged before me in the County of ________________, State of Colorado, this ____day of ___________, 20____, by the Applicant. My Commission Expires: ________________

_____________________________________________ Notary Public/Deputy Clerk ______________________________________ Signature of Attorney Date

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APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR

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