District Court Denver Probate Court

___________________ County, Colorado

Court Address:

In the Interest of:

COURT USE ONLY
Ward/Protected Person
Attorney or Party Without Attorney (Name and Address): Case Number:

Phone Number: E-mail:

FAX Number: Atty. Reg.#: Division Courtroom
NOTICE OF DEATH
This notice is submitted pursuant to §§15-14-314(2)(g), C.R.S. and/or 15-14-431(1), C.R.S.

1. (name), who died on (date)

was the subject of a Guardianship and/or Conservatorship.

2. 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 and the conservator will
conclude administration of the conservatorship estate pursuant to §§15-14-428 and 15-14-431, C.R.S.

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)

at ______________________________________
(city or other location, and state OR country)

_______________________________
(printed name)

_______________________________
(signature)

CERTIFICATE OF SERVICE
I certify that on ___________________ (date), a copy of this _______________ (name of document) was served
as follows on each of the following:

JDF 853SC R9/18 NOTICE OF DEATH

 Name and Address

Relationship to Decedent, Ward,

Manner of Service*
or Protected Person

*Insert one of the following: hand delivery, first-class mail, certified mail, e-service, or fax.

__________________________________________
Signature

JDF 853SC R9/18 NOTICE OF DEATH