Fill and Sign the Application for Informal Appointment of Special Administrator Pursuant to 15 12 614 Crs Colorado

 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): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR PURSUANT TO §1 5-12-614, 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: Mailing Address, if different: City: State: Zip Code: Home Phone #: Email Address: Work Phone #: 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. JDF 924 R8-17 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 1 of 5 ©2017 Colorado Judicial Department for use in the Courts of Colorado  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.  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 reasonable diligence, the Applicant is unaware of any unrevoked Will relating to property in Colorado. or  The date of the Decedent’s last Will is . The dates of all codicils are . The Will and any codicils are referred to as the Will. The Applicant believes that it is the Decedent’s last Will and that it was validly executed. Except as may be disclosed in an attached explanation and after the exercise of reasonable diligence, the Applicant is unaware of any instrument revoking the Will and is unaware of any prior Wills relating to property in Colorado that have not been expressly revoked by a later instrument.  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. The original document  will be delivered to the Court forthwith or  has been delivered to the Court.  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.) 8. Decedent’s marital and family status: a) Did a spouse or partner in a civil union survive the Decedent?  Yes  No If the answer to a) is Yes, also answer the following questions: b) Did the Decedent have a surviving parent?  Yes  No c) Did the Decedent have surviving children or other descendants?  Yes  No If the answer to c) is Yes, also answer the following questions: 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 If the answer to e) is No, also answer the following question: f) Are any of the Decedent’s children minors?  Yes  No JDF 924 R8-17 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 2 of 5 ©2017 Colorado Judicial Department for use in the Courts of Colorado 9. 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 listed, 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.) 10. 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.) 11.  Applicant is 21 years of age or older and nominates himself/herself to be appointed as Special Administrator. or  Applicant nominates the following person be appointed as Special Administrator. Name: The Nominee is 21 years of age or older. Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone #: JDF 924 R8-17 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 3 of 5 ©2017 Colorado Judicial Department for use in the Courts of Colorado Email Address: Work Phone #: 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. Persons with prior or equal rights to appointment are as follows:  They have each renounced their rights to appointment or have been given notice of these proceedings. Any required renouncements accompany this Application.  No notice has been given because an emergency exists and appointment should be made forthwith. 12. Applicant states the following regarding the Decedent’s estate. Estimated value of real estate $ Estimated value of personal property $ Annual income expected from all sources $ TOTAL $ 13. The Special Administrator may receive compensation.  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. 14. 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. JDF 924 R8-17 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 4 of 5 ©2017 Colorado Judicial Department for use in the Courts of Colorado * There is a continuing obligation to disclose any material changes to the basis for charging fees. (§ 15-10-602 C.R.S.) 15. Bond in the amount of $ is requested. (§15-12-603(1)(a), C.R.S.)  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. (Checking this box requires you to remove JDF number and copyright at the bottom of the form.) 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. VERIFICATION AND ACKNOWLEDGMENT I (Applicant) verify that the facts set forth in this document are true as far as I know or am informed. I understand that penalties for perjury follow deliberate falsification of the facts stated herein. (§15-10-310, C.R.S.) ____________________________________________ Signature of Applicant Date The foregoing instrument was acknowledged before me in the County of ________________, State of Colorado, this ____day of ____________, 20___, by the Applicant. My Commission Expires: ________________ _____________________________________________ Notary Public/Deputy Clerk ______________________________________ Signature of Attorney Date JDF 924 R8-17 APPLICATION FOR INFORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 5 of 5 ©2017 Colorado Judicial Department for use in the Courts of Colorado