Fill and Sign the Makes the Following Statements Form

JDF 924 SC R6/19 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 1 of 5 ❑ District Court ❑ Denver Probate Court ___________________ County, Colorado Court Address: In the Matter of the Estate of : Deceased COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address): Phone Number: E -mail: FAX Number: Atty. Reg. #: Case Number: 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: Relationship to Decedent Street Address : City: _____________________ State: ______________ Zip Code: ___________________________ Mailing Address, if different: City: State: Zip Code: Primary Phone: ________________________ Alternate Phone: _____________ ________________ Email Address: 2. The decedent , ___________, died on (date) at the age of years. The decedent was domiciled or resided in the City of County of , 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. JDF 924 SC R6/19 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 2 of 5 ❑ 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. ❑ Except as may be disclosed in an attached explanation and after the exercise of reas onable diligence, the applicant is unaware of any instrument revoking the w ill and is unaware of any prior w ills relating to property in Colorado that have not been expressly re voked by a later instrument. or ❑ The date of the decedent’s last will is . The dates of all codicils are . The will and any codicils are collectively referred to as “the will.” The applicant believes that it is the decedent’s last will and that it was validly executed. 8.❑ 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 and the original will must be delivered to the court immediately ❑ 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. ) 9. Decedent’s marital and family status: a) Did a spouse or partner in a civil union survive the decedent? ❑ Yes ❑ No b) Did the decedent have a surviving parent? ❑ Yes ❑ No c) Did the decedent have surviving children or other descend ants? ❑ Yes ❑ No d) Does the decedent’s surviving spouse or partner in a civil union have surviving descendants who are not descendants of the decedent? ❑ Yes ❑ No e) Are all of the decedent’s surviving descendants also descendants of the surviving spouse or partner in a civil union? ❑ Yes ❑ No f) Are any of the decedent’s children minors? ❑ Yes ❑ No 10. List names and addresses of decedent’s spouse, partner in a civil union, 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 liste d, list the child’s parent (s) , guardian or conservator. ◆ If a spouse , partner in a civil union, or child has predeceased the decedent, include the date of death . Name Address or Date of Death Age, only if Minor Relationship (e.g. spouse, partner in a civil union, child, brother, guardian for spouse, etc.) JDF 924 SC R6/19 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 3 of 5 11. 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. ) 12. ❑ Applicant is 21 years of age or older and nominates himself or herself to be appointed as special administrator. or ❑ Applicant nominates the fo llowing person be appointed as special administrator. Name: The Nominee is 21 years of age or older. Street Address : City: ___________________ State: _________ Zip Code: __________________ Mailing Address, if different: City: State: Zip Code: Primary Phone: __________________ Alternate Phone: __________________________ Email Address: 13. 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. ❑ The persons with prior or equal right to appointment are _____________________________(name). All p ersons with prior or equal right to appointment have executed a required renouncement that accompanies this application. 14. Applicant states the following regarding the decedent’s estate . (§ 15 -12 -604, C.R.S.) Estimate d value of real estate $ Estimate d value of personal property $ Annual income expected from all sources $ TOTAL $ 15. The special administrator may receive compensation. ❑ The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, JDF 924 SC R6/19 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 4 of 5 including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated , are as stated below or in an attachment to this application. * ❑ The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (§ 15 -10 -602 C.R.S.) 16. The special administrator may compensate his, her , or its counsel. ❑ The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated , are as stated below or in an attachment to this application. * ❑ The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (§ 15 -10 -602 C.R.S.) 17. 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 . ❑ By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. ❑ By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and corre ct. Executed on the ______ day of Executed on the ______ day of (date) (date) _______________________, _________, _______________________, _________, (month) (year) (month) (year) at ______________________________________ at ______________________________________ (city or other location, and state OR country) (city or other location, and state OR country) _______________________________ __________________ _____________ (printed name) (printed name) JDF 924 SC R6/19 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 5 of 5 _______________________________ _______________________________ (Signature of Applicant ) (Signature of Co -Applicant, if any) ________________________________________ __________________ Attorney Signature, (if any) Date Note: • Please remember to add any AKA names in the caption, if applicable.