JDF 94 5 SC R 9/18 NOTICE OF DISALLOWANCE OF CLAIMS 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 NOTICE OF DISALLOWANCE OF CLAIMS PURSUANT TO 247 1 5 - 12 - 806, C.R.S. To: ( c laimant): The p ersonal r epresentative of this estate disallows the claim presented on (date ) as follows : all of your claim. $ of your claim in the amount of $ . Failure to protest any disallowance by filing a Petition for Allowance of Claims or commencing a proceeding within 63 days after the mailing of this n otice will result in your claim or the disa llowed portion being forever barred. Date: Signature of Personal Representative Print Name of Personal Represent ative Address City, State and Zip Code Phone Number VERIFICATION I declare under penalty of perjury unde r 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 JDF 94 5 SC R 9/18 NOTICE OF DISALLOWANCE OF CLAIMS CERTIFICATE OF SERVICE I certify that on (date), a copy of this (name of document) was served as follows on each of the following: Name and Address Relationship to Decedent, Ward, or Protected Person Manner of Service* *Insert one of the following: hand delivery, first - class mail, certified mail, e - ser vice, or fax. Signature American LegalNet, Inc. www.FormsWorkFlow.com