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JDF 727 SC R6/19 WITHDRAWAL OR SATISFACTION OF CLAIM AND RELEASE 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 WITHDRAWAL OR SATISFACTION OF CLAIM AND RELEASE I, _____________________________________ (claimant), hereby grant a full and final release to the estate and to the fiduciary and any successor for any liability in connection to t he claim(s) described below and ❑ withdraw the claim. ❑ acknowledge that the claim has been satisfied. 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 c hecking this box, I am acknowledging that I have made a change to the original content of this form. 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) JDF 727 SC R6/19 WITHDRAWAL OR SATISFACTION OF CLAIM AND RELEASE Page 2 of 2 at ______________________________________ (city or other location, and state OR country) _______________________________ (printed name) __________ _____________________ (signature)