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City: <br />_ State: —Zip Code: <br />Email Address: <br />The Petitioner shall provide the persons listed in paragraphs 4, 9, 10 and 43 —'16 (Respondent's spouse, <br />nomiiTee, current Guardian or Conservator, parents, adult children or an adult relative, person who had <br />primary care and control of the Respondent and any legal representatives, it applicable) with notice of the <br />time and place for hearing on this Petition in accordance with Colorado Rules of Probate Procedures and <br />pursuantto §15.14 -404, C.R. S. <br />In addition, I request that the Court: <br />VERIFICATION AND ACKNOWLEDGMENT <br />I swearlaffirm under path that 1 have read the foregoing Petition and that the statements set forth therein are true <br />and correct to the best of my knowledge. <br />7 <br />S` not re of Petitioner <br />SLLbscribed and affinred, or swom to before me In !he County of daze&2 5ta:e of <br />, th i s (I"— dey Rf 20 f O <br />fAN fil�jo <br />My Commission expires: J <br />i <br />q ; PUB L C: <br />'�pFcoti -� <br />