JDF 727 SC R 6 /1 9 WITHDRAWAL OR SATISFACTION OF CLAIM AND RELEASE Page 1 of 2 District Court Denver Probate Court County, Colorado Court Address: In the Interest of: In the Matter of the Estate of: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom WITHDRAWAL OR SATISFACTION OF CLAIM AND RELEASE I, ( c laimant), hereby grant a full and final release to the estate and to the fiduciary and any successor for any liability in connection to t he claim(s) described below and withdraw the claim. acknowledge that the claim has been satisfied. Date(s) Obligation Incurred Type or Description of Claim or Service Amount Total $ By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By c hecking 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 and correct. Executed on the day of , , (date) (month) (year) American LegalNet, Inc. www.FormsWorkFlow.com JDF 727 SC R 6 /1 9 WITHDRAWAL OR SATISFACTION OF CLAIM AND RELEASE Page 2 of 2 at (city or other location, and state OR country) (printed name) (signature) American LegalNet, Inc. www.FormsWorkFlow.com