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: __________________

Division ______ Courtroom ________ Phone Number: ________________ E-mail: ____________________ FAX Number: __________________ Atty. Reg. #: _______________

VERIFIED APPLICATION FOR CERTIFICATE FROM REGISTRAR PURSUANT TO §15-12-1007, C.R.S.
I, _______________________________________________, as the Personal Representative Surety state:

1. The appointment of _____________________________________ (name) as Personal Representative of this estate has terminated. 2. The Personal Representative has fully administered this estate according to law. 3. No action concerning this estate is pending in any court.

I request that the Registrar issue a Certificate stating that this estate appears to have been fully administered and evidencing discharge of any lien on any property given to secure the obligation of the Personal Representative in lieu of bond or any surety.

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

Date: __________________________

______________________________________ Signature

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 967 9/08

VERIFIED APPLICATION FOR CERTIFICATE FROM REGISTRAR