Colorado Code
Article 22 - Designated Beneficiary Agreements
§ 15-22-111. Revocation of a Designated Beneficiary Agreement

REVOCATION
OF DESIGNATED BENEFICIARY AGREEMENT
I __________ (insert your full name), reside at __________ (insert your current address) and I entered into a designated beneficiary agreement on __________ (insert the date) with the following person __________ (insert the other person's name) whose last-known address is __________ in which I designated such person as a designated beneficiary. This designated beneficiary agreement was recorded on __________ (insert the date) in the county of __________. The indexing file number of the designated beneficiary agreement is __________. I hereby revoke that designated beneficiary agreement, effective on the date and time that this revocation is received for recording by the clerk and recorder of __________ county. ________________ __________ Name Date STATE OF COLORADO County of __________ This document was subscribed, sworn to, and acknowledged before me on __________ date by __________ My commission expires __________ [Seal] __________________________ Notary Public This revocation of beneficiary agreement was recorded in my office on , , at o'clock, and, pursuant to section 15-22-111, Colorado Revised Statutes, I mailed a copy of this revocation of beneficiary agreement to at the address contained in this revocation of beneficiary agreement. Clerk and Recorder of __________ County By: __________
Source: L. 2009: Entire article added, (HB 09-1260), ch. 107, p. 437, § 1, effective July 1. L. 2013: (3) amended, (SB 13-011), ch. 49, p. 167, § 25, effective May 1.

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