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Domiciliary Foreign Personal Representative'S Sworn Statement

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District Court

Denver Probate Court

__________________________________ County, Colorado

Court Address:

______________________________________

In the Matter of the Estate of:

______________________________________

Deceased

COURT USE ONLY

Attorney or Party Without Attorney (Name and Address):

Case Number: _________________

________________________________________

Phone Number:________________ E-mail: ___________________

FAX Number:__________________ Atty. Reg. #:: _______________

Division ______ Courtroom ________

DOMICILIARY FOREIGN PERSONAL REPRESENTATIVE’S SWORN STATEMENT

I, _____________________________________, as the domiciliary foreign personal representative (§15-10-

201(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

Domiciliary Foreign Personal Representative'S Sworn Statement

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