Fill and Sign the Cntr Book Updated 010919 City of Manhattan Beach Form

❑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 Without Attorney (Name and Address): Case Number: Phone Number: FAX Number: Division E-mail: Atty. Reg. #: Courtroom RECEIPT AND RELEASE Received from _________________________________________, ❑Conservator ❑Partial ❑Full payment and satisfaction of the following: ❑the devise to me in the will under article(s) ❑my share of the estate as a devisee in the will. ❑my share of the estate as an heir. ❑my distribution from the conservatorship case. ❑Other: ❑Personal Representative . ❑Cash in the amount of $ __________________. ❑Tangible personal property described as: * ❑Real property described as: * ❑The following securities: * JDF 731SC R6/19 RECEIPT AND RELEASE Page 1 of 2 ❑Other (describe): * ❑I grant a partial release and satisfaction to the estate and to the fiduciary and any successor as to the above partial distribution. ❑I grant a full and final release and satisfaction to the estate and to the fiduciary and his or her successors for any liability in connection with my interest in the estate. ❑ 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. *Attach additional sheets as necessary. _________________________ Date ____________________________________________ Signature of Person Acknowledging Signing Receipt and Release _____________________________________________________ Print Name 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) JDF 731SC R6/19 RECEIPT AND RELEASE Page 2 of 2