HomeMy WebLinkAbout11-25-14 (2) r��.�
�'? c:;� ,�i
r7
�'., Q � ��� C'�
t::J � �-..�i �"� CJ
`�'7 —_Y�_ � C— G� r'7
.,_.� • `w�
.., -,.y Y__ �� R..4 �-1
-- ,
, _. ._,., ,� ,
��
. . t ..7
ANNUAL REPORT OF � � ` '" '
....� . j _.�
GUARDIAN OF THE ESTATE -- �'' �' -�'
. . �-,
. : c..� ;__ r�7
3 .�:�; r_
Q �� o
.- � �
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of AI HUA CHEN , an Incapacitated Person
No. 11-1184
I. INTRODUCTION
Kong Ji Chen ,was appointed
0 Plenary �Limited Guardian of the Estate by Decree of Hon. Albert H. Masland �J.�
dated November 28,2011
� A. This is the Annual Report for the period from ,
to , (the"Report Period"); or
� B. This is the Final Report for the period from November 28, � 2013
to September 11 � 2014 (the"Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death: 09/11/2014
Name of Personal Representative: Letters being Applied for,Kong Ji Chen
2. The Guardianship was terminated by the Court by Decree of
J., dated
Form G-02 rev.10.13.06 Page 1 of 5 � `�
, r ,\
��
I.,/
Estate of AI HUA CHEN ,An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $ 80,908.45
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report,
otherwise, ending balance from last Report.) $ 80,908.45
C. What is the total amount of income earned during the
Report Period? $ 12,067.96
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $ 10,966.33
E. What are the balances remaining at the end of the Report
Period?
1. Principal $ 23,908.45
2. Income $ 1,101.63
3. Total of Principal and Income $ 25,010.08
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additional pages.)
A. Principal
1. How is the principal balance listed above currently
invested? (Please specify, e.g.,real estate,
certificates of deposit,restricted bank accounts, etc.):
The equiry in the real estate at 7 Hedge Row Lane, Carlisle,PA, of
approximately$57,000,vested in Guardian as surviving joint tenant with
right of survivorship; and the remaining balance is held in a restricted
guardianship account at Wels Fargo Bank,N.A., Carlisle, PA.
Note: the $57,000.00 value for the equity in the real estate was approximate,
and a formal appraisal with be done as part of the administration of estate.
2. Have there been any expenditures from the principal
during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . ❑Yes ❑No
Form G-02 rev.10.73.06 Page 2 of 5
Estate of AI HUA CHEN ,An Incapacitated Person
b. List purpose and amount of expenditures:
$
$
$
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No
3. Were additional principal assets received during the
Report Period which were not included in the
Inventory or a prior Report filed for the Estate? . . . . . . . . . . . �Yes �✓ No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . . . ❑Yes ❑No
b. State the sources and amounts of the
additional principal received:
$
$
$
$
$
B. Income
1. State sources and amounts of income received
during the Report Period(e.g., Social Security,
pension,rents, etc.):
Social Security $ 2,763.00
Workers Compensation payments � 9,304.96
�
$
$
$
Total income received during Report Period: $ 12,067.96
Form G-02 rev.10.13.06 Page 3 of 5
Estate of��NA CHEN ,An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g.,restricted bank accounts, client
care account, etc.):
It is in a restricted Guardianship Account at Wells Fargo,N.A., in
Carlisle,PA.
C. Expenses for Care and Maintenance
Specify what expenditures were made from the principal and
income for the care and maintenance of the Incapacitated
Person(e.g., clothing,nursing home,medicine, support, etc.):
Haircuts and misc.personal expenses $200.00
1/2 of mortgage paytnents on Jt.residence 7,575.66
• Met-Ed Electric Bill on Residence 2,809.19
South Middleton Authority Water Bill 581.48
Total: $10,966.33
D. Other Expenditures
Specify what other expenditures were made during the Report
Period. (Do not include any items stated in response to
question C above.)
None
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was deternuned:
Court
Amount Method of Determination Approval Obtained
0.00 Not Applicable �Yes �No
�Yes �No
Fo,m c-oz rev.10.13.06 Page 4 of 5
Estate of��A CHEN ,An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
550.00 �Yes �No
�Yes �No
I verify that the foregoing information is correct to the best of my knowledge,
infortnation and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities.
November ,2014 � ��Y
Date Sign�e o�ian of the Estate
Kong Ji Chen
Name of Guardian of the Estate(type or print)
7 Hedge Row Lane
Address
Carlisle,PA 17015
city,srare,ztp
(717)218-8989
Telephone
Form G-02 rev.10.13.06 Page 5 of 5