JDF 929 SC R 6 /1 9 District Court Denver Probate Court County, Colorado Court Address: I n 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 I, , as the domiciliary foreign personal representative (247 15 - 10 - 201(16.5) C.R.S.), state that no administration, or application or petition for administration, is pending in Colorado. I hereby file with this c ourt the following documents: Certified, exempl ified , representative; Certified, exemplified , evidencing or affecting my authority to act as personal representative; Other: 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) American LegalNet, Inc. www.FormsWorkFlow.com