Fill and Sign the Co Certificate Application Form

 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 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 the Registrar 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  Surety STATE 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. CPC 28-A R7/00 APPLICATION FOR CERTIFICATE FROM REGISTRAR 1 This form conforms in substance to CPC 28-A.