JDF 726 SC R 6 /1 9 CLAIM 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 Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CLAIM Name of Claimant: Street A ddress: City: State: Zip Code : Mailing Address, if different : City: State: Zip Code : Primary Phone : Alternate Phone: Claim is made against this estate, itemized as follows: 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 checking this box, I am acknowledging that I have made a change to the original content of this form. American LegalNet, Inc. www.FormsWorkFlow.com JDF 726 SC R 6 /1 9 CLAIM Page 2 of 2 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) RECEIPT I, , received a copy of this claim on (date). Signature of: Personal Representative Conservator Note : Decedent Estate Action For i nformation on claim s not due and contingent or un liquidated claims , see 247 15 - 12 - 810, C.R.S. All claims defined pursuant to 247 15 - 10 - 201(8), C.R.S. must be filed with the c ourt or presented to the p ersonal r epresentative of the estate. If pr esented to the p ersonal r epresentative, either this form or a written statement complying with 247 15 - 12 - 804, C.R.S. can be used. If filed with the c ourt, C.R.P.P. 10 provides that either this form or a form that substantially follows the approved JDF be u sed. If this form is presented to the p ersonal r epresentative, the r eceipt may be completed. Protect ive Proceeding Estate Action This form can be used for the presentation and allowance of claims filed with the c ourt pursuant to 247 15 - 14 - 429, C.R.S. If this form is presented to the conservator , the r eceipt may be completed . American LegalNet, Inc. www.FormsWorkFlow.com