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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: William A. Sipe
a/k/a:
a/k/a:
a/k/a:
Date of Death: Mav 22, 2012
File No: ~ ~ _ ~ a ~ ~~
(Assigned by Register)
Social Security No:
Age at death: 64
Decedent was domiciled at death in New Castle Count
principal residence at _1600 Shadvbrook Road, Wilmineton, DE 19803 y' DelaWilmineton (crate) with his/her last
Street address, Post Office and Zip Code City, Township or Borough Count
Y
Decedent died at St. Francis Hosnital Wilmineton, DE 19803
Street address, Past Office and Zip Code City, Township or Borough County
State
Estimate of value of decedent's property at death:
If domiciled in Pennsy!vania ............................ All personal property
If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania
If not domiciled in Pennsy!vania ........................ Personal property in County
Value of real estate in Pennsylvania ........................................................ .
TOTAL ESTIMATED VALUE... .
$ n nn
$ n nn
$ 1 ~ R 400 00
S 138.400 00
Real estate in Pennsylvania situated at: Easy ROad, Carl].S12, PA 17015
(Attach additionat sheets, ifnecessary.) Street address, Post office and Z~ Code Lower Frankford Township Cumberland
P City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated
thereto dated and Codicil(s)
State relevant circumstances (eg. renunciation, death of executor, etc.)
Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS ~ EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d. b. n., d.b.n.c.t.a., pendente life, durante absentia, durance minoritate
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and com lete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS ~ EXCEPTIONS
Petitioner(s), aftera proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs
additional sheets, if necessary): ~ ~ ~
Name Relationshi w
Suzanne Sipe Address v
Wife 16('0 Shady Brook Road, Wilmington, DE 19803 ._aj
. Ns~
0
N
Form RW-02 rev. l0/11/2011
x _.
s ~
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^, x
Page 1 of 2
i
t
i ne retit~oner(s) above-named swear(s) or af}irm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Dec en the Petitio s) it well and truly administer the estate according to law.
Sworn to r affirmed a d subscribed before
me this y of ~ ~~ ~ Date / _.. / Z
$y; ~ Date
For the Register Date
Date
Letters .................. $ ,~ ~
( )Short Certificate(s)...... `~
( ( )Renunciation(s)......... t-j .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ............ .
Other ...... ,
........
Automation Fee . .............. _ ~'~1 1
JCS Fee . .................... ~ ;-~ ~ ; ('J
TOTAL ..................... $ 0.00
Attorney Signature:
v f
Printed Name: lyse E. Rogers ~ ~ N
~ x _
Supreme Court ;~,
ID Number: 41274 ~ ~=
Firm Name: Saidis, Sullivan & Rogers _
~ r N _
Address: 635 North 1 th 4 rPgt< Snit 400 _
~ ~ ~ .., x ~;
I..mo ng PA 17043 - N
Phone: 717-612-5801
Fax: 717-612-5805
Email: Prnop,~(~ccr-attnrneyc rnm
DECREE OF THE REGISTER
Estate of William A. Sine
a/k/a: File No• ,-;~ ~ - `;~ ~ ~ ~. .
AND NOW, ~- ~ C `; ~ ~ ~ ~~ -111 -~L~ ~
satisfactory proof havm b~ ~ ~~ in consideration_of the forgoing Petition,
g presented before me, IT IS DECREED that~.etters j~Q~,~ V1 ~ ~ ~~ ~(1~~
are hereby granted to f= ((1 ~~ h (, /'rn r , r-
the instrument(s) dated U krh the above estate and (if applicable) that
described in the Petition be admitted to probate and filed of record as the last Will (and Co icil(s)) of Decedents
egister of Wills ~ ~ ~~
-- ;~ /
,~ ,
Form RW-Ol rev. 10/11/10/1 ~~' ~ ~ ; ~ ~~,~~~
~±`k ~ Page 2 of 2
BOND Required: ®YES Q NO To the Register of Wills:
FEES: Please enter m a
y ppearance by my signature below:
Oath of Personal Representative ors~~at use on~y
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
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(i, I )FFICE CIF VITAL CERTIFICATE OF DEATH
u STATISTICS ~tdtQ Off ~QY8hi8t'C (107)
PARTMENT OF
HEALTH AND SOCIAL SERVICES State File Number
-T---------~ ---
I 11 ;1EC.EDE VTSI.EGAi NPMF /In~~i„no eue~.r ,.... ~. rr•,...~ .....,_ ~ -------
.i"
.~ -
L848857~
fS~ \11 1 F
~Ur;lAi_ SECURITY NUMBER
G~ 11 i am William A. Si e S i~e___ Ma 1 e lci5-38-8659
~ ACE-La ;t Ninhday 4b
UNDER 1 YEAR 4
. .
c. UNDER 1 DAV S., DATE OF E31RTH 6 BIRTHPLACE Cit --------
( Y and State or F ~raign C ountryl
(Years? '
MO/Day/Vr)
64 Monms Days Hours Minutes M
! arch 9, 1948 Carlisle, PA
7
RE
a
SIDENCE-STATE 7b. COUNTY 7c. CITY OR TOWN --- -------
Delaware
New Castle Wilmin ton
7tl STREET AND NUMBER
7e APT. NO. 7f. ZIP CODE [] \e5 ~-No
d 79irrsloE CirY UM TS?
1600 Shad
brook R
y
oa
19803
i e EVER IN US 9. MARITAL STATUS AT TIME OF DEATH 10. SURVIVING SPOUSE'S NAME If wife. ---
ARMEDFQROES? Married ^ Widowed ^Divorced ( give nom/ prior to sirsr maniage)
^ Y'
~
es (
No ^ Never Married ^ Unknown
Suzanne Peart
11
'
~
vo . FATHER
S NAME (Firs[, Middle, Last)
William Alexa
d
Si 12. MOTHER'S NAME PRIOR TO FIRST MARRIAGE (Flrsl Middle. Last)
n
er
pe Marie F. Morrison
w 13a INFORMANT'S NAME - 13b. RELATIONSHIP TO DECEDENT 13
-
do
Suzanne Si
e c.
MAILING ADDRESS (Street and Number. ~;ity, Slate. lip Code.
d J p wife 1600 Shadybrook Road Wi1m., Dl: 19803
J ~ 10. PLACE OF DEATH (Check only one; see instructions)
W
U 2
~
m _- _
_-_ _.__ ___ --__..~. __ _ _ _ __ _ _ _ __
IF DEATH OCCURRED IN A HOSPITAL'. IF DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL.
~ Inpatient ^ Emergency Room/Outpalient ^ Dead
A
LL on
mval ^ Hospice faplit
y ^ Nursirg homelLong [e care facility ^ Decedent s hon e ^ Othe (.~peci'y)'
15. FACfLITV NAME (If not 'nslrtution,gTve stroet & number) i6
C
T
~ .
I
Y OR TOWN ,STATE, ANp ZIP CODE
17 COUNTY OF DEATH
St. Francis Hos it
l
a
Wilmin ton Delaware 19805 New Castle
16. METHOD OF DISPOSITION: ^ Burial Cremation 19. PLACE OF DISPOSITION (Name of cemete
ry, crematory, other pycel
^ Donation ^ Entombment ^ Removal from State
^ omer s ~ HCCrery 6 Hama Cremat
ory
20. LOCATION-CITY, TOWN, AND STATE 21. NAME AND COMPLETE ADDRESS OF FUNERAL FACILRV ----
Wilco ton DE McCrary dr Hama Funeral Hoes S Cre
t
a~I
ory, lnc:.
22. ATURE FUNERAL SER E CE E OTHER AGEN7 ~ (~
,
. , LI MBER (Crt Lip;nsee)
ITEM 8 MUST BE COMPLETED BY PER WHO za. DATE PRONOUNC o !000474
RONOU
PRONOUNCES OR CERTIFIES DEATH (MO/Daym) 25. TIME P
NCED DEAD
.
~ L t ~/'"
~
~
26. SIGNATURE OF RSON PRONOUNCING DEATH (Only when applicable) 27. LICENSE NUMBER
--~-
:8 ,DATE SIGNED (Iv1o/Day/Vr)
Ca.-ooo9r3~ ~/zr
-~_
.
29. ACTUAL OR PRE MED DATE OF DEBT 30. ACTUAL OR PRESUMED TIMEQ~ ATH 31 WAS MEDICAL EXAMINER CONTACTED?
(Mo/Day/Vq (Spell onth) 5 ~2'L~IL r
~
~
,
'
s ~: YSS ^ No
CAUSE OF DEATH {See instructions and examples)
32
PART A
.
L Enter the chain devents-diseases,, injuries, or complkations-tMl direc/ly caused the death. 00 NOT enter terminal events such as wrdi.
arrest
respirato
c
arrest
or v
t
i
l
fi pproximate
interval:
,
.
ry
,
en
r
cu
ar
brillation wdhout sftovring the etiology. DO NOT ABBREVIATE. Eller only one cause on a line. Adtl additional
lines N necessary. Clnset to death
IMMEDIATE CAUSE (Final Metastatic nonsmall
tlisease or condition •->
ll
a.
Ce
lung cancer
resultin
in d
th
g
ea
) Due to (a as a alnsequence o - ---- - -
Sequentially list contlifions, b.
tt any
leadin
ro th
,
g
e cause Due to (or as a consequence ot): --
listed on Ilne a. Enter the ~-
UNDERLYING CAUSE c.
(disease orin
th
jury
at Due to (or as a consequence of). --
initiated the events resulting -
in death) LAST d
PART 11. Enter other significant condTons conUihW'nn to death bW not resulting in the undadying cause given in PART I
33. WAS AN Al1TOPSY PERFORMED?
m W ^ Yes () No ^ Unknown
ia
34. WERE AUTOPSY FINDINGS AVAILABLE TO
-
m H COMPLETE: THE CAUSE OF DEATH?
o W 35. DID TOBACCO USE CONTRIBUTE 36. FF FEMALE: ^ Yes ^ No ^ Unknown -
E V
o ~ TO DEATH? 37. MANNER OF DEATH
^ Not pregnant within pass year
;.,
U <
~ G ^ Pregnant at hme of death (]gJatu~al
^ Yes ^ Probably ^ Not pregnant but pregnant within 42 days of death ~ ^ Hom cide
owl
- ., ^ Not pregnant but pregnant 43 days to 1 year before death ^ Accident ^ PenO ng Investgation
u ;:~ ,q ~ ,drown
~ ;
r:
r
'
,
,
.
ww
r p;eynal~ v: i !n ripe pa I year
^ Suicde ^ CouM not be determined
3 6. GATE OF INJURY ~ fig. T{k1E OF INJURY d0. PLACE'OF I JTN t7R`/ (o,p , Decedont'a home; conslrudpn spo;.resteur
(MO/(}ayKr)7SpN MOrrlh} artC wgoded areaj 47. INJURY AT MV
t7 ,Yes ^ Nb
4 4. LOCAT( OF -
9te06' '
,
City prTrnm'
-. StreetBNla116er-
t 3. i)ESCRfBE 1NJUA1'iSCC'•URRED:.. N°.: Cole' " - -
' ~4 IF TI7ANSp 7A 1QNIN.lURY" SPEGFY- '
~] DhccNOperatgr
` ^ Passenger
r] Pedes7i(rn +
4 5 C IFIER (Ch ck o ly on)
^ a5 ~_
~
Certifying phys c a To the best of my k edge a[h occurred tlue to the cause(s) d nner stated.
Prono
i
8
' unc
ng
Cedlfyt g physicia best of my nowledge deam occurred at me r tlale, and place and tlue to the causa(sl and morn
er stated
~ Medical ~xam'Iner•on eke d
_
- -
~
y
anyo
yn. 'm;:ESed1 accitmetl11Ld1epgB, date, and plaoa, and cue to d1a caa9e(a)andrhandat'Staled
S ignature of cedRiec
' S. ~iAME. ADDRESS. AND ZIP CODE OF PERSON COMPLETING CAUSE OF DEATH (Item 32) --
R
4/ obert J. Brus, D.O. 111 Continental Drive Newark De 19713
TITLG OF CERTIFIER 48. LICENSE NUMBER 49. DATE C RTI ED (Mo/Day/Yr) 50 FOR REGISTRAR ONLY -DATE FILED
-. (MWDaylYr)
D.O. _ 5315
------.._._ __.._._._.. _. _ S i" ~~. ~tAY 2 d ~nt~
t t nJ is to certlry mat cols Is a true and correct
reproduction or abstract of the official record filed
with the Delaware Division of Public Health.
Any alteration of this document is prohibited. Do not
accept unless on security paper with thg raised seal of
the Office of Vital Statistics.
.-...~
- Stat egl trar
r
i
f
i (M'i V
H f n
~ ~ z z
i i
f ~ ~ ~
N ., x
l
~;r.a
f
RENUNCIATION ~ = = x
~
~~ -
~~-~~~'
REGISTER OF W1LLS ~' = ~ ~~'
CUMBERLAND
COUNTY
PENNSYLVANIA ~ f ~ v
, V N N x
Estate of William A. Sipe
Deceased
I, Suzanne Sipe
(PrdnrNameJ , in my capacity/relationship as
Surviving Spouse of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Elyse E. Rogers
(Dade) ~~
(J'ignatureJ `''
1600 Shady Brook Road
(Street Address)
Wilmington, DE 19803
(Cary, State, Zrp)
Executed in Register's Offce
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purpos s stated within on this --~ day
~ f ~ G' ! ~
~ (~, ~
~'~Q
Notary Public
My Commission Expires: ~/%~ J~ `j`~
(Signature and Seal of Notary or other official qualified to
administer oaths. Shinv date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06