Fill and Sign the Claim is Made Against This Estate Itemized as Follows Form

JDF 726 SC R6/19 CLAIM Page 1 of 2 ❑ District Court ❑ Denver Probate Court ___________________ County, Colorado Court Address: ❑ In the Interest of: ❑ In the Matter of the Estate of: COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address): Phone Number: E -mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CLAIM Name of Claimant: _______________________________ __________________________________ Street Address: _________________________________________________________________ City: __________ State: ___________ Zip Code : ______________ Mailing Address, if different : ______ _____________________ City: ___________ State: __________ Zip Code : _______________ Primary Phone : ______________________________________________ Alternate Phone: _____________________________________________ Claim is made against this estate, itemized as follows: Date(s) Obligation Incurred Type or Description of Claim or Service Amount Total $ ❑ 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. JDF 726 SC R6/19 CLAIM Page 2 of 2 VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of ___________, _________, (date) (month) (year) at ______________________________________ (city or other location, and state OR country) _______________________________ (printed name) ___________________ ____________ (signature) RECEIPT I, _________________, received a copy of this claim on (date). ______________________________________ Signature of: ❑ Personal Representative ❑ Conservator Note : Decedent Estate Action • For i nformation on claim s not due and contingent or un liquidated claims , see § 15 -12 -810, C.R.S. All claims defined pursuant to § 15 -10 -201(8), C.R.S. must be filed with the court or presented to the personal representative of the estate. • If pr esented to the personal representative, either this form or a written statement complying with § 15 -12 -804, C.R.S. can be used. If filed with the court, C.R.P.P. 10 provides that either this form or a form that substantially follows the approved JDF be u sed. • If this form is presented to the personal representative, the r eceipt may be completed. Protect ive Proceeding Estate Action • This form can be used for the presentation and allowance of claims filed with the court pursuant to § 15 -14 -429, C.R.S. • If this form is presented to the conservator , the r eceipt may be completed .