District Court Denver Probate Court _________________________________ County, Colorado Court Address: _______________________________________ In the Interest of: COURT USE ONLY Case Number:__________________ _____________________________________ Protected Person Division_____ Courtroom __________ CERTIFICATE OF ANCILLARY FILING - CONSERVATORSHIP The foreign conservator’s sworn statement stating that no administration, application, or petition for administration is pending in Colorado, has been filed with this Court. The following documents regarding have been filed with this Court: , as the foreign conservator, Certified, exemplified, or authenticated copy of the foreign court’s order appointing the foreign conservator. Certified, exemplified, or authenticated copy of the foreign court’s letters or other documents evidencing or affecting the foreign conservator’s authority to act. Certified, exemplified, or authenticated copy of any bond of the foreign conservator. Other: The attached documents(s) is/are certified to be a true copy of the certified exemplified authenticated copy of the document(s) referenced above that is/are in my custody. Date: ________________________________ JDF 892 R4/09 ___________________________________________ (Deputy) Clerk or Registrar of Court CERTIFICATE OF ANCILLARY FILING – CONSERVATORSHIP American LegalNet, Inc. www.FormsWorkFlow.com