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): ________________________________________ ________________________________________ Phone Number:________________ E-mail: ___________________ FAX Number:__________________ Atty. Reg. #:: _______________ COURT USE ONLY Case Number: _________________
Division ______ Courtroom ________
DOMICILIARY FOREIGN PERSONAL REPRESENTATIVE'S SWORN STATEMENT
I, _____________________________________, as the domiciliary foreign personal representative (ยง15-10201(16.5) C.R.S.), state that no administration, or application or petition for administration, is pending in Colorado. I hereby file with this Court the following documents: Certified, exemplified or authenticated copies of the foreign court's order appointing me as personal representative; Certified, exemplified or authenticated copies of the foreign court's letters or other documents evidencing or affecting my authority to act as personal representative; Other: _______________________________________________________________________________ As the domiciliary foreign personal representative 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 Domiciliary Foreign Personal Representative
_____________________________________________ 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 929
11/07
DOMICILIARY FOREIGN PERSONAL REPRESENTATIVE'S SWORN STATEMENT