Colorado Code § 15-23-111

Filing statement
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(1) A custodian shall submit a filing statement for each
electronic estate planning document for each creator submitted to the state court administrator
pursuant to this article 23.
(2) A custodian shall provide the following information and make the following
declarations on a filing statement form furnished by the state court administrator:
(a) A declaration that after attempting to transfer possession of the original estate
planning document to its creator as provided in section 15-23-105:
(I) The custodian cannot locate the creator of the original document;
(II) The creator has not taken possession of the original document; or
(III) The custodian has neither been able nor required to transfer possession of the
original document to someone other than the creator under applicable law other than this article
23;
(b) The name of the creator, last name first;
(c) All aliases of the creator, last name first, known to the custodian;
(d) The date of birth of the creator, if known to the custodian;
(e) Subject to subsection (3) of this section, the last mailing and physical addresses of
the creator known to the custodian;
(f) Regarding the custodian:
(I) If the custodian is an individual, the name and address of the individual;
(II) If the custodian is an entity, the name and address of the entity, the name and
position of the individual acting on behalf of the entity, and the individual's address if different
than that of the entity;
(g) For the electronic estate planning document filed:
(I) The name and date of the electronic document;
(II) The category of the original document, as described in section 15-23-103 (13), that
has been converted to an electronic document; and
(III) The number of pages of the electronic document;
(h) A declaration that the custodian, or if an entity, the officer of the custodian,
submitting the filing statement has:
(I) Examined the original estate planning document;
(II) Based upon that examination, believes that the document is an original estate
planning document of the creator, as those terms are defined in section 15-23-103;
(III) Compared the electronic estate planning document with the original estate planning
document; and
(IV) Based upon that comparison, believes that the electronic estate planning document
is a true and correct copy of the original estate planning document;
(i) (I) A declaration that, if the custodian is subject to the Colorado rules of professional
conduct, the custodian has complied with the rules as they may relate to this filing;
(II) For the purpose of the declaration made pursuant to this subsection (2)(i), the state
court administrator shall refer to the Colorado rules of professional conduct as the "Colorado
Rules of Professional Conduct adopted by the Supreme Court of Colorado";
(j) A declaration that the custodian has complied with all applicable law other than this
article 23; and
(k) A declaration that the act of submitting a filing statement to the state court
administrator subjects the submitter and the individual on whose behalf the submitter is acting to
the penalty of perjury, pursuant to section 15-23-110, for the information provided and
declarations made in the filing statement, whether or not the individual is named in the filing
statement as the one submitting the filing statement.
(3) In the case of an original estate planning document found in a safe deposit box, it is
sufficient under subsection (2)(e) of this section to furnish the last mailing and physical
addresses of the lessee or lessees of the safe deposit box known to the custodian.
(4) Information provided and declarations made in the filing statement are part of the
profile for each creator.

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