District Court Denver Probate Court __________________________________ County, Colorado Court Address: In the Interests of: COURT USE ONLY Protected Person Attorney or Party Without Attorney (Name and Address): Case Number: Phone Number: FAX Number: Division E-mail: Atty. Reg. #:: Courtroom FOREIGN CONSERVATOR’S SWORN STATEMENT I, ____________________________________, as the foreign conservator (§15-14-433, C.R.S.), state that a conservator has not been appointed in this state and no petition in a protective proceeding is pending in Colorado for the protected person. I hereby file with this Court the following documents: Certified, exemplified, or authenticated copies of the foreign court’s order appointing me as conservator; Certified, exemplified, or authenticated copies of the foreign court’s letters or other documents evidencing or affecting my authority to act as conservator; Certified, exemplified, or authenticated copies of any bonds filed with the appointing foreign court; Other: ______________________________________________________________________________. As the foreign conservator and being sworn, I verify that the facts set forth in this statement are true to the best of my knowledge, information, and belief. Date: ___________________________ _____________________________________________ Signature of Foreign Conservator _____________________________________________ Street _____________________________________________ City/State/Zip Code _____________________________________________ Daytime Phone Number Subscribed and affirmed, or sworn to before me in the County of ______________________, State of __________________, this ___________ day of _______________, 20______. My Commission Expires: ___________________ JDF 891 11/07 _____________________________________________ FOREIGN CONSERVATOR’S SWORN STATEMENT American LegalNet, Inc. www.FormsWorkflow.com Notary Public/Deputy Clerk JDF 891 11/07 FOREIGN CONSERVATOR’S SWORN STATEMENT American LegalNet, Inc. www.FormsWorkflow.com