Verified Application For Certificate From Registrar Pursuant

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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: __________________
_____________________________________________
_____________________________________________
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

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