JDF 926 SC R 6 /1 9 PETITION FOR FORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 1 of 5 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 PETITION FOR FORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR PURSUANT T O 247 15 - 12 - 614, C.R.S. The p etitioner , an interested person pursuant to 247 15 - 10 - 201(27), C.R.S., makes the following statements: 1. Information about the p etitioner : Name: Relationship to Decedent Street Address : City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: 2. The d ecedent , , died on (date) at the age of years. The d ecedent was domiciled or resided in the City of County of , State of . 3. Venue for this proceeding is proper in this county because the d ecedent: had his or her domicile or residence in this county on the date of death. did not have his or her domicile or residence in Colorado, but had property located in this county on the date of death. 4. This p etition is filed within the time period permitted by law. Three years or less have passed since the d , or circumstances described in 247 15 - 12 - 108, C.R.S. authorize tardy probate or appointment. 5. The p etitioner : has not received a D emand for Notice of Filings or Orders and is unaware of any D emand for N otice of Filings or Orders concerning Decedent. has received or is aware of a D emand for N otice of Filings or Orders concerning Decedent . See attached Demand for Notice of Filings or Orders or explanation. American LegalNet, Inc. www.FormsWorkFlow.com JDF 926 SC R 6 /1 9 PETITION FOR FORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 2 of 5 6. No court has appointed a p ersonal r epresentative and no such appointment proceeding is pending in this state or elsewhere. A court has appointed a p ersonal r epresentative or an appointment proceeding is pendi ng in the State of . ( Attach a statement explaining the circumstances and indicating the name and address of the p ersonal r epresentative. Attach a certified copy of the appointing document if the appointment has been finalized.) 7. Except as may be disclosed in an attached explanation and after the exercise of reasona ble diligence, the p etitioner is unaware of any instrument revoking the w i ll and is unaware of any prior w ills relating to property in Colorado that have not been expressly revoked b y a later instrument. or The date of the d w ill is . The dates of all codicils are . The w ill and any codicils collectively are referred to as the w ill. The p etitioner believes that it is the d w ill and that it was validly executed. 8 . The original w ill : was deposited with this c ourt before the d 15 - 11 - 515, C.R.S.) has been delivered to this c ourt since the d 15 - 11 - 516, C.R.S.) is filed with this p etition. An e - filed copy of the w ill is filed with this petition and the original w ill must be delivered to the c ourt immediately . The w ill has been probated in the State of . Authenticated copies of the w ill and of the statement probating it are filed with this p etition. ( 247 15 - 12 - 402, C.R.S. ) 9. a) Did a spouse or partner in a civil union survive the d ecedent? Yes No b) Did the d ecedent have a surviving parent? Yes No c) D id the d ecedent have surviving children or other descend a nts? Yes No d) Does the d or partner in a civil union have surviving descendants who are not descendants of the d ecedent? Yes No e) Are all of the d surviving spouse or partner in a civil union ? Yes No f) Are any of the d Yes No 10. List names and addresses of d partner in a civil union, children, heirs and devisees. If a g uardian or c onservator has been appointed for one of the persons listed below, also provide the name and address of the g uardian or c onservator. arent (s), g uardian or conservator . If a spouse , partner in a civil union, or child has predeceased the d ecedent, include the date of death . Name Address or date of death Age, only if Minor Relationship (e.g. spouse, partner in a civil union, child, brother, guardian for spouse, etc.) American LegalNet, Inc. www.FormsWorkFlow.com JDF 926 SC R 6 /1 9 PETITION FOR FORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 3 of 5 11. Petitioner requests appointment of a s pecial a dministrator to preserve the estate or to secure its proper administration for the following reasons : ( 247 15 - 12 - 614( 1)(b), C.R.S. ) 12. Petitioner is 21 years of age or older and nominates himself or herself to be appointed as s pecial a dministrator. O r Petitioner nominates the fo llowing person be appointed as s pecial a dministrator. Name: The Nominee is 21 years of age or older . Street Address : City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: 13. The n ominee has priority for appointment because of: statutory priority (247 247 15 - 12 - 203, 15 - 12 - 615 , and 15 - 12 - 621(9), C.R.S.) reasons stated in the attached explanation The persons with prior or equal right to appointment are (name). All persons with prior or equal right to appointment have executed a required renouncement that accompanies this application. No notice has been given because an emergency exists and appointment should be made immediately . 1 4. Petitioner states the following regarding the d 247 15 - 12 - 604, C.R.S. ) Estimate d v alue of r eal e state $ Estimate d v alue of p ersonal p roperty $ A nnual i ncome e xpected from all s ources $ TOTAL $ 1 5 . The s pecial a dministrator may receive compensation. The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated , are as stated below or in an attachment to this p etition . * American LegalNet, Inc. www.FormsWorkFlow.com JDF 926 SC R 6 /1 9 PETITION FOR FORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 4 of 5 The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (247 15 - 10 - 602 C.R.S.) 1 6 . The s pecial a dministrator may compensate his, her or its counsel. The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated , are a s stated below or in an attachment to this p etition . * The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (247 15 - 10 - 602 C.R.S.) 1 7 . Bond is not required by the w ill (if any) nor has any interested person demanded that bond be filed. Bond in the amount of $ has been demanded . After notice and hearing, the p etitioner requests that the c ourt formally appoint the n ominee as s pecial a dministrator to serve: without bond . with bond in the amount of $ and that Letters of Special Administration be issued . 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. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true a nd correct. Executed on the day of Executed on the day of (date) (date) , , , , (month) (year) (month) (year) at at (city or other location, and state OR country) (city or other location, and state OR country) American LegalNet, Inc. www.FormsWorkFlow.com JDF 926 SC R 6 /1 9 PETITION FOR FORMAL APPOINTMENT OF SPECIAL ADMINISTRATOR Page 5 of 5 (printed name) (printed name) (Signature of Petitioner ) (Signature of Co - Petitioner , if any) Attorney Signature, (if any) Date Note: Please remember to add any AKA names in the capt