Fill and Sign the Receipt Release 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): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom RECEIPT AND RELEASE Received from _________________________________________,  Personal Representative  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:  Cash in the amount of $ __________________.  Tangible personal property described as: *  Real property described as: *  The following securities: * JDF 731SC 9/18 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 9/18 RECEIPT AND RELEASE Page 2 of 2