STATE OF COLORADO)

) ss.

County of ................................................)In the

In the matter of)District Court.

the application of)

................................................................)Petition.

to register the title to the land hereinafter described.

To the Honorable ........................, judge of said court: I hereby make application to have registered the title to the land hereinafter described, and do solemnly swear that the answers to the questions herewith, and the statements herein contained, are true to the best of my knowledge, information and belief.

First - Name of applicant,....................… age,… years. Residence,..........… (number and street, if any). Married to ....................… (name of husband or wife).

Second - Application made by ........................, acting as ......… (owner, agent or attorney). Residence,......… (number, street).

Third - Description of real estate is as follows:...............................….....................…

.......................................................................................................................................…

.......................................................................................................................................…

estate or interest therein is ..........… and ..........… subject to homestead.

Fourth - The land is ..........… occupied by ..........… (names of occupants), whose address is ......… (number, street, and town or city). The estate, interest or claim of occupant is ....................................… .

Fifth - Liens and encumbrances on the land ............................................................… .....................................................................................................................................… .

Name of holder or owner thereof is ........… whose post-office address is ........… .

Amount of claim, $ .… . Recorded, Book ...., page ...., of the records of said county.

Sixth - Other persons, firms, or corporations, having or claiming any estate, interest, or claim in law or equity, in possession, remainder, reversion, or expectancy in said land are .......................................................................................................................................…

.......................................................................................................................................…

whose addresses are .......................................................................................................…

respectively. Character of estate, interest, or claim is ......................................................…

......................................................................................................................................… .

Seventh - Other facts connected with said land and appropriate to be considered in this registration proceedings are .....................................................................................…

......................................................................................................................................… .

Eighth - Therefore, the applicant prays this honorable court to find and declare the title or interest of the applicant in said land and decree the same, and order the registrar of titles to register the same and to grant such other and further relief as may be proper in the premises.

By .............., agent, attorney, administrator, or guardian.

Subscribed and sworn to before me this ..........… day of .............., A.D. 20… .

..................................,

Notary Public.