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 VERIFIED NOTICE OF DEATH PURSUANT TO §15-14-431(1), C.R.S. AND §15-14-314(2)(g),C.R.S. 1. ___________________________________________ (full name), who died on ___________________ (date) was the subject of a Conservatorship and/or Guardianship. 2. The Court, in its Order Appointing Guardian or Conservator, ordered that notice of all proceedings be given to the following person(s): Full Name Address Relationship 3. The Guardian’s authority to act on behalf of the ward has terminated. The Conservator’s authority to act on behalf of the Protected Person is limited pursuant to §15-14-428 & 431, C.R.S. Note: The Conservator is directed to conclude administration pursuant to §15-14-431, C.R.S. I swear/affirm under oath that I have read the foregoing Verified Notice of Death and that the statements set forth therein are true and correct to the best of my knowledge. ______________________________________ Signature of Guardian/Conservator Date Subscribed to and affirmed or sworn to before me in the County of __________________, State of ________________, this ______ day of ___________, 20 _____, by ___________________________________. My Commission Expires: ____________________ __________________________________________ Notary Public/Clerk CERTIFICATE OF SERVICE I certify that on ________________________ (date) a copy of this Order was served on each of the following: Full Name Relationship Ward *Insert one of the following: to Address Manner of Service* Hand Delivery, First-Class Mail, Certified Mail, E-Served or Faxed. ___________________________________________ Signature JDF 853 11/07 VERIFIED NOTICE OF DEATH American LegalNet, Inc. www.FormsWorkflow.com