Fill and Sign the Application for Certificate from Registrar Form

CPC 28-A R7/00 APPLICATION FOR CERTIFICATE FROM REGISTRAR 1This form conforms in substance to CPC 28-A. District Court  Denver Probate Court_________________________________________ County, ColoradoCourt Address:IN THE MATTER OF THE ESTATE OF:Deceased: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg.#:Case Number:Division Courtroom APPLICATION FOR CERTIFICATE FROM REGISTRAR The undersigned states:1. The appointment of _____________________________________________________________as personal representative (Name) 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.4. Pursuant to Section 15-12-1007 of the Colorado Probate Code, the undersigned is entitled to receive a Certificate from theRegistrar 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. ___________________________________________Signature of  Personal Representative  Surety____________________________________________________________________________________________________________________________________________________________________________Type or Print name, address & tele.# of  Personal Representative  SuretySTATE OF ________________________________________________________COUNTY OF ________________________The undersigned, being sworn, states: That the facts set forth in the foregoing Application are true to the best of the undersigned’s knowledge, information and belief. ___________________________________________Signature of  Personal Representative  Surety Subscribed and sworn to before me on:___________________________________________________ ___________________________________________ Notary Public/(Deputy) Clerk of Court My commission expires ________________________________NOTE: This Application is pursuant to Section 15-12-1007 of the Colorado Probate Code.