HomeMy WebLinkAbout06-11-13 : __ . . _ _._ . . _
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NAME OF TRUST
(TR UST UNDER WILL OF Kell y Lei�h Mellott Special Needs Trust
or
TRUST UNDER DEED OF
DATED )
No.� �I " I'?�-l'��t�S:�.
PETITION FOR ADJUDICATION/
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C.Rule 6.9
This form may be used in all cases involving the Audit of Trust Accounts. If space is insuff cient,
riders may be attached.
INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel: Lacy Hayes, Jr., Esquire
Supreme Court I.D. No.:
Name of Law Firm:
Address: 2216 Walnut Street,Harrisburg, PA 17103-2426
Telephone: ��17)234-0700
Fax:
Form OG02 rev 10./3.06 Page 1 of 10
�
Name of Trust: Kelly Leigh Mellott Special Needs Trust
l. Name(s)and address(es) of Petitioner(s):
Petitioner: Petitioner:
Na,,,e: AmeriServ Trust& Financial
Add,.ess: 216 Franklin Street
Johnstown, PA 15901
2. Check if any of the following issues are involved in this case:
A. Appointment of Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
B. Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
C. Discharge of Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m
D. Transfer of Situs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
E. Appointment of Ad Litem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
F. Minor, Unborn or Unascertained Beneficiary(ies) . . . . . . . . . . . . . . . . . . . . . . �
G. Principal Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
H. Partial/Full Termination of Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
I. Missing Beneficiary(ies) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
J. Cy Pres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
K. Williamson Issue* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
L. OtherIssues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
List:
Please note:
A detailed explanation of issues checked should be set forth at item 13 below.
�`See Williamson Estate,368 Pa.343,82 A.2d 49(1951),if Trustee was also Executor of the setdor/decedent's estate and
received commissions in such capacity.
Form OG02 rev 10.13.06 Page 2 of 10
Name of Trust: Kelly Leigh Mellott Special Needs Trust
3. Testamentary Trust:
Decedent's date of death: N/A
Date of Decedent's Will: N/A
Date(s) of Codicil(s): N/A
Date of probate: N/A
or
Inter Vivos Trust:
Date of Trust: October 6, 2008
Date(s)of Amendment(s): None
4. A. If any other Court has taken jurisdiction of any matter relating to this Trust, explain:
N/A
B. Identify all prior accountings and provide dates of adjudication.
N/A
5. A. State how each Trustee was appointed:
Ms. Mellott's parents appointed AmeriServ Trust& Financial Services Co.
B. If a Petitioner is not a Trustee, explain:
N/A
Form OC-02 rev 10.13.06 Page 3 of 10
Name of Trust: Kelly Leigh Mellott Special Needs Trust
6. State how and when the present fund was awarded to Trustee(s):
Funded from a personal injury lawsuit-November 17, 2008
7. Period covered by accounting: November 17,2008 to May 9, 2013
8. Current fair market value of the Trust principal is $ 1,115.79 . (See page
2 of Account.)
9. State concisely the dispositive provisions of the Trust:
The trustee may pay to, or provide for the benefit of the beneficiary, as much of the net
income and the principal as the Trustee,in his/her sole discretion,may from time to time
think desirable, in such amounts or proportions as the Trustee may from time to time
think appropriate, in his/her sole discretion, except as limited in paragraph VII.G.
hereinafter. The Trustee may otherwise distribute discretionary amounts of income
and/or principal for special needs not otherwise provided by governmental financial
assistance and benefits, or by the providers of services,which will not cause the
beneficiary to be ineligible for governmental financial assistance benefits, in the event
that beneficiary is receiving such benefits.
10. Explain the reason for filing this Account(if filed because of the death of a party, state
name of person, relationship to Trust and date of death):
Trust funds have depleted to a diminimous value
Form OC-02 rev 10.13.06 Page 4 of 10
Name of Trust:Kelly Leigh Mellott Special Needs Trust
11. State why a Petition far Guardian/Trustee Ad Litem has or has not been filed for this
Audit(see Pa. O.C. Rule 12.4):
A Guardian/Trustee Ad Litem is not required because Mr. &Mrs. Mellott are
representing Kelly
12. A. State the amount of Pennsylvania Transfer Inheritance Tax and Pennsylvania Estate
Tax paid(including postponed tax on remainder interests),the dates of payxnent and
the interests upon which such amounts were paid:
Date Payment Interest
N/A
B. If any such taxes remain unpaid or are in dispute, explain:
None
13. Describe any questions requiring Adjudication and state the position of Petitioner(s)and
give details of any issues identified in item 2:
Petitioner desires to be discharged as trustee and the remaining funds to be distributed to
Mr. &Mrs. Mellott to be applied to expenses for Kelly.
Fo,m oc-oz rev 10.13.06 Page 5 of 10
Name of Trust:Kelly Leigh Mellott Special Needs Trust
14. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will
be given to all parties in interest listed in item 15 below. In addition,notice of any
questions requiring Adjudication as discussed in item 13 above has been or will be given
to all persons affected thereby. .
A. If Notice has been given, attach a copy of the Notice as well as a list of the names
and addresses of the parties receiving such notice.
B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and
addresses of the parties receiving such Notice shall be submitted at the Audit
together with a statement executed by Petitioner(s) or counsel certifying that such
Notice has been given.
C. If any such party in interest is not sui juris (e.g., minors or incapacitated persons),
Notice of the Audit has been or will be given to the appropriate representative on
such party's behalf as required by Pa. O.C. Rule 5.2.
D. If any charitable interest is involved,Notice of the Audit has been or will also be
given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition,
the Attorney General's clearance certificate(or proof of service of Notice and a
copy of such Notice)must be submitted herewith or at the Audit.
15. List all parties of whom Petitioner(s)has/have notice or knowledge,having or claiming
any interest in the Trust,whether such interest is vested or contingent, charitable or
non-charitable. This list shall:
A. State each party's relationship to the Settlor/Decedent and the nature of each
party's interest(s);
Name and Address of Each Party in Interest I Relationship and Comments,ifany I Interest
Marvin&Cindy Mellott Parents
901 Second Street
New Cumberland, PA 17070
Lacy Hayes Jr., Esquire
2216 Walnut Street
Harrisburg,PA 17103-2426
Fo.m ocoz rev 10.l3.06 Page 6 of 10
Name of Trust: Kelly Leigh Mellott Special Needs Trust
Name and Address of Each Party in lnterest I Relationship and Comments,ifany I Interest
Department of Public Welfare Remainder
B. Identify each party who is not sui juris (e.g.,minors or incapacitated persons).
For each such party, give date of birth,the name of each Guardian and how each
Guardian was appointed. If no Guardian has been appointed, identify the next of
kin of such party, giving the name, address and relationship of each; and
N/A
C. If distribution is to be made to the personal representative of a deceased party,
state date of death, date and place of grant of Letters and type of Letters granted.
N/A
16. If Petitioner(s)has/have knowledge that a Trust share has been assigned or attached,
provide a copy of the assignxnent or attachment, together with any relevant supporting
documentation.
17. If a trustee's principal commission is claimed:
A. If based on a written agreement,attach a copy thereof.
Form OC-02 rev 10.13.06 Page 7 of 10
.
FEE SCHEDULE
The annual fee for Irrevocable Trusts, Special Needs Trusts and Guardianship
Accounts is based on the fair market value of the account and is computed as follows:
BASE FEE $250
MARKET VALUE PERCENT
First$1 million 1.00%
Next $2 million .80%
Next $2 million .60%
Over$5 million .40%
TRANSACTION CHARGES---DISBURSEMENTS
0 to 24 $0.00
Greater than 24 $5.00 each
PRINCIPAL DISBURSEMENTS 1.00%
MINIMUM FEE $1,500
ADDITIONAL FEES (charged at current rate)
• Visitations
• Court appearances
• Court accountings
• Agency reports
• T�Preparation
ACCOUNT TERMINATION FEES
Additional fees will be charged for all accounts opened as follows:
• Asset Transfer/Registration charges - $20/per security/per certificates transferred
Name of Trust:Kelly Leigh Mellott Special Needs Trust
B. If a principal commission is claimed, state amount.
$1,145.09
C. If a principal commission is claimed, state the amounts and dates of any principal
commissions previously paid in prior accounting periods.
Amount Date Paid
Fee is taken monthly
18. If a reserve is requested, state amount and purpose.
Amoant: 3�g.34
F"'P°Se: Trustee fee for 6/1/13 -6/30/13 $83.34
Tax prep fee $175.00
Accounting fee $50.00
If a reserve is requested for counsel fees, has notice of the
amount of fees to be paid from the reserve been given to the
parties in interest? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
If so,attach a copy of the notice.
19. Is the Court being asked to direct
the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . �Yes �No
Form OG02 rev 10.13.06 Page 8 of 10
Name of Trust: Kelly Leigh Mellott Special Needs Trust
Wherefore,your Petitioner(s)ask(s) that distribution be awarded to the parties entitled
and suggest(s) that the distributive shares of income and principal(residuary shares being stated
in proportions,not amounts)are as follows:
A. Income:
Proposed�istributee(s) Amount/Proportion
B. Principal:
Proposed Distributee(s) Amount/Proportion
Parents of Kelly Mellott $563.95
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
` � ���/lL�i�,
-ytlt
Nam of Petitioner: AmeriServ Trust& Financial
Services Co. Trustee
Name of Petitioner:
Form OC-02 rev 10.13.06 Page 9 of 10
Name of Trust: Kelly Leigh Mellott Special Needs Trust
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that heisne she is r�rre Vice President
of the above-named name ofcorporadon AmeriServ Trust&Financial Service �d] that the facts set
forth in the foregoing Petition for Adjudication/Statement of Proposed Distribution which are
within the personal knowledge of the Petitioner are true,and as to facts based on the information
of others,the Petitioner, after diligent inquiry,believes them to be true; and that any false
statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating to unsworn
falsification to authorities).
��
Si ature of Petitioner
*Corporate petitioners must complete bracketed information.
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court, and that no changes to the form have been made beyond the
responses herein.
Signature of Counsel for Petitioner
Fo,m oc-oz rev 10.13.06 Page 10 of 10
_ _ _.. . n �.� _ _ _. _
_ _,.
��i � � �� ��� ��—� � — d���
IN THE COURT OF CONIMON PLEAS OF CUMBERLAND COUNTY, PA.
ORPHANS' COURT DIVISION
FIRST AND FINAL ACCOUNT OF AMERISERV TRUST AND FINANCIAL SERVICES
COMPANY, TRUSTEE OF THE KELLY LEIGH MELLOTT IRREVOCABLE SPECIAL NEEDS TRUST
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Accounting for the period: November 17, 2008 to May 9, 2013
Purpose of Account: The Trustee offers this Account to acquaint interested
parties with the transactions that have occurred during the Administration.
It is important that the Account be carefully examined. Requests for
additional information, questions or objections can be discussed with:
Dana Garland
Vice President & Personal Trust Manager
AmeriServ Trust and Financial Services Company
PO Box 520
Johnstown, PA 15907-0520
(814) 533-5231
PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 1 -
�
SUMMARY OF ACCOUNT
PAGES
PRINCIPAL
Receipts 3 $ 21,131.25
Less Disbursements;
TAX RETURN PREPARER'S FEE 4 $ lOQ.OQ
Pa Depar�ment of Revenue 4 l•00
Fiduciary Fees 4 1,145.09
Legal Fees 4 93.75
Administration - Misc. Exp. 5 75.00
General Disbursements 5-6 18.428.42 -19 843.26
Balance before Distributions $ 1.28�•9g
Principal Balance on Hand 7 $ 1,287.99
INCOME
Receipts 8-9 $ 4,088.16
Less Disbtzrsements IQ-11 -4 260.36
Balance before Distributions $ -172.20
Incame Balance on Hancl 12 $ -172-20
COMBINED BAL,ANCE ON HANI3 $ 1, 116.79
------------------
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PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 2 -
PRINCIPAL RECEIPTS
SUBSEQUENT RECEIPTS
11/17/08 Cash receipt, Court Settlement, Personal
Injury Claim $ 21, 131.25
TOTAL PRINCIPAL RECEIPTS $ 21, 131.25
------------------
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PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 3 -
DISBURSE'i�lENTS OF PRINCIPAL
TAX RETURN PREPARER'S FEE
ADMINISTRATION EXPENSES
04/30/09 Tax preparation fee � 100.00 $ 100.00
STATE FIDUCIARY INCOME TAX
PA Department of Revenue
04/09/09 2008 Form PA-41, balance due 1.00 1.00
FIDUCIARY FEES
TRUSTEE FEES
11/02/11 $ 41.67
12/02/11 41.67
O1/04/12 41.67
O1/25/12 Principal Distribution Fee 20.05
02/06/12 41.67
03/06/12 41.67
04/05/12 41.67
05/04/12 41.67
06/06/12 41.67
07/06/12 41.67
08/06/12 41.67
09/07/12 41.67
10/04/12 83.34
11/06/12 83.33
12/06/12 83.33
O1/07/13 83.33
02/06/13 83.33
03/06/13 83.33
04/04/13 83.34
05/06/13 83.34 1,145.09 1, 145.09
LEGAL FEES
LEGAL/ATTORNEY FEES
12/06/10 Edward P Carey, Esquire $ 43.75
12/31/10 John W Giltinan, Esquire 50.00 93.75 93.75
FORWARD $ 1,339.84
PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 4 -
DISBURSII�NTS OF PRINCIPAL (cont'd)
FORWARD $ 1,339.84
ADMINISTRATION - MISC. EXPENSES
ADMINISTRATION EXPENSES
03/15/12 Accounting Preparation Fee $ 25.00
12/20/12 Accounting Preparation Fee 50.00 75.00 75.00
GENERAL DISBURSEMENTS
CindY Mellott, Reimbursements
O1/26/10 Large Screen TV for Kelly $ 1,430.99
02/03/10 Share of Stone Harbor, NJ, Vacation,
6/26/10 to 7/03/10 512.50
07/08/10 New Furniture
Ceiling Fan
Wall Mount & HDMI's for TV,
for Kelly's Bedroom 2,476.33
O1/27/11 Computer, Printer & Ink for Kelly 1,600.19
02/10/11 Ipod Touch & 2 Wii Games for Kelly 496.76
05/27/11 Spending Money for Kelly 500.00
11/10/11 Share of Stone Harbor, NJ, Vacation,
6/23/2012 to 6/30/2012 1, 008.00
O1/05/12 Extension of Stone Harbor, NJ, Vacation 750.00
06/07/12 Spending Money for Kelly 500.00
08/31/12 Camera & Accessories for Kelly 606.71
12/17/12 Diller & Fisher Realtors,
Reservation for Stone Harbor, NJ 1, 008.00
05/08/13 Plane Ticket, Car Rental,
Park Tickets & Spending Money 2,200.00 13, 089.48
House repairs and maintenance, relative
to Kelly LeiQh Mellott
06/16/10 Scott Snyder, Patching & Painting
Walls, Trim & Ceiling
for Kelly's Bedroom 390.00
OTHER DISBURSEMENTS
03/08/12 Horse Back Riding Lessons $ 270.00
03/22/12 Timberline Four Seasons Reality 476.44
05/25/12 Horse Back Riding Lessons 270.00 1,016.44
FORWARD $ 14,495.92 $ 1,414.84
PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 5 -
DISBURSEMENTS OF PRINCIPAL (cont'd)
FORWARD $ 14,495.92 $ 1,414.84
GENERAL DISBURSEMENTS (cont'd)
02/17/12 Transfer to Income 2,596.36
02/17/12 Transfer to Income 792.90
09/07/12 Transfer to Income 501.57
10/02/12 Transfer to Income 41.67 18,428.42
TOTAL DISBURSEMENTS OF PRINCIPAL $ 19,843.26
---------------
---------------
PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 6 -
PRINCIPAL BALANCE ON HAND
FIDUCIARY
VALUE AT ACQUISITION
05/09/2013 VALUE
Cash Invested in Money Mkt Fd $ 1,287.99 $ 1,287.99
TOTAL PRINCIPAL BALANCE ON HAND $ 1,287.99 $ 1,287.99
------------------ ------------------
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PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 7 -
RECEIPTS OF INCOME
Cash
02/17/12 Transfer to Income $ 2,596.36
02/17/12 Transfer to Income 792.90
09/07/12 Transfer to Income 501.57
10/02/12 Transfer to Income 41.67 $ 3, 932.50
Goldman Sachs Prime Obliqations Fd
12/O1/08 Interest $ 13.59
O1/02/09 Interest 27.76
02/02/09 Interest 18.60
03/02/09 Interest 9.94
04/O1/09 Interest 9.37
05/O1/09 Interest 8.55
06/O1/09 Interest 7.07
07/O1/09 Interest 5.78
08/03/09 Interest 4.11
09/O1/09 Interest 3 .19
10/O1/09 Interest 2.74
11/02/09 Interest 1.89
12/O1/09 Interest 1.93
O1/04/10 Interest 3.16
02/O1/10 Interest 0.83
03/O1/10 Interest 0.76
04/O1/10 Interest 1.03
05/03/10 Interest 1.30
06/O1/10 Interest 1.62
07/O1/10 Interest 2.11
08/02/10 Interest 2.40
09/Ol/10 Interest 2.50
10/O1/10 Interest 2.10
11/O1/10 Interest 1.91
12/O1/10 Interest 1.70
O1/03/11 Interest 1.57
02/O1/11 Interest 1.53
03/O1/11 Interest 1.16
04/O1/11 Interest 0.93
05/02/11 Interest 0.78
06/O1/11 Interest 0.76
07/O1/11 Interest 0.50
08/O1/11 Interest 0.27
09/O1/11 Interest 0.48
10/03/11 Interest 0.76
FORWARD $ 144.68 $ 3, 932.50
PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 8 -
RSCSIPTS OF INCOME (cont'd)
FORWARD $ 144.68 $ 3, 932.50
Goldman Sachs Prime Obliaations Fd
(cont'd)
11/O1/11 Interest 0.72
12/O1/11 Interest 0.71
O1/03/12 Interest 0.83
02/Ol/12 Interest 0.81
03/O1/12 Interest 0.82
04/02/12 Interest 0.82
05/O1/12 Interest 0.72
06/O1/12 Interest 0.75
07/02/12 Interest 0.68
08/O1/12 Interest 0.73
09/04/12 Interest 0.59
10/Ol/12 Interest 0.53
11/O1/12 Interest 0.53
12/03/12 Interest 0.44
O1/02/13 Interest 0.36
02/Ol/13 Interest 0.28
03/O1/13 Interest 0.22
04/O1/13 Interest 0.25
05/O1/13 Interest 0.19 155.66
TOTAL RECEIPTS OF INCOME $ 4,088.16
---------------
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PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 9 -
DISBURS$MENTS OF INCOME
ADMINISTRATION EXPENSES
04/30/09 Tax preparation fee $ 100.00
04/29/10 Tax preparation fee 125.00
04/22/11 Tax preparation fee 125.00
03/29/12 Tax preparation fee 175.00
03/27/13 Tax preparation fee 175.00 $ 700.00
TRUSTEE FEES
11/02/11 $ 41.66
12/02/11 41.66
O1/04/12 41.67
02/06/12 41.66
03/06/12 41.67
04/05/12 41.67
05/04/12 41.66
06/06/12 41.67
07/06/12 41.66
08/06/12 41.66
09/07/12 41.67 458.31
Trust Co Pathroad Fee Collected
11/04/OS $ 10.08
11/19/08 Refund of 11/04/08 fee -10.08
12/02/08 27.48
O1/05/09 27.48
02/03/09 27.47
03/03/09 27.46
04/02/09 27.45
05/04/09 27.29
06/02/09 27.28
07/02/09 27.26
08/04/09 27.24
09/02/09 27.23
10/02/09 27.21
11/03/09 27.19
12/02/09 27.17
O1/OS/10 27.16
02/02/10 26.11
03/02/10 25.73
04/02/10 25.71
05/04/10 25.60
06/02/10 25.59
FORWARD $ 511.11 $ 1,158.31
PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 10 -
DISBURSEMENTS OF INCOME (cont�d)
FQRWARD $ 5I1.11 $ 1,158.3I
Trust Co Pathroad Fee Collected {cont'd}
07JQ2j10 25.29
08/03/10 23 .52
09j42/IO 23.51
10/04/10 23.49
11/02j10 23.48
12{02j10 23.44
O1/04/11 23.36
Olj27j11 17.79
02/02/11 21.67
03f30j11 83.34
04/04/11 $3.34
05f03/11 83.33
06f02f11 83.34
07/05/11 83.33
�8j02jIl 83.33
09/02/11 83.33
10f44j1I 83.33 2,383.33
ADMINISTRATION SXPENSES
O1j0'7/10 Accounting Preparation Fee $ 25.00
11f26j14 Accaunting Preparation Fee 25.0� 50.00
Cindy Mellott� Reimbursements
01107111 Mattress & share af stone xarbar, �7J',
Vaca�.ion
6j25/2411 to 7j2j2011 $ 752.49
02/10/11 Ipod Touch & 2 Wii Garnes far Kelly 16.23
42j18/11 Share of Addi�ional Week at Stane
Harbor, NS, Vacation
�/ls/2oii to �1a5/aoii �oo.ao i.6�s.�a
TOTAL DISBURSEMENTS OF INCOME $ 4,26p.36
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PA3391-09 Kelly Leigh Mellott Zrrev Special Needs Trust - 11 -
INCOME BALANCE ON HAND
FIDUCIARY
VALUE AT ACQUISITION
05/09/2013 VALUE
Cash Invested in Money Mkt Fd $ -172.20 $ -172.20
TOTAL INCOME BALANCE ON HAND $ -172.20 $ -172.20
------------------ ------------------
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PA3391-09 Kelly Leigh Mellott Irrev Special Needs Trust - 12 -
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CAMBRIA :
On this 3�S� day of '�``��� , 2013, before me, a Notary Public, in
and for the above County and State, personally appeared, Dana Garland, Vice President
& Personal Trust Manager, of AmeriServ Trust and Financial Services Company, Trustee
of the Kelly Leigh Mellott Irrevocable Special Needs Trust, who being duly sworn
according to law deposes and says that the foregoing account and statement of proposed
distribution is true and correct to the best of her knowledge.
AMERISERV TRUST AND FINANCIAL SERVICES
COMPANY, TRUSTEE OF THE KELLY LEIGH
MELLOTT IRREVOCABLE SPECIAL NEEDS
TRUST
1��. l�t�
Dana Garland
Vice President & Personal Trust Manager
Sworn to and subscribed to
before me this 3(�-� day of
r'"`�-�, , 2013.
��C�.�u� `-'�L-�x,`
Notary Public
COMMONWEqLTN OF PENNSYLVANIA
Notarial Seal
Debra l.PutlBner,Notary Public
��Y°����atown.Cambria County
Member,�n�i��s Aug.8,2013
Y� Association of Notaries
In the Court of Common Pleas of Cumberland County, PA.
Orphans' Court Division
AmeriServ Trust and Financial Services Company,
Trustee of the Kelly Leigh Mellott
Irrevocable Special Needs Trust
STATEMENT OF PROPOSED DISTRIBUTION
Balance of personal property in the hands of the accountant for
Distribution as shown by the account, consisting of the following:
Cash $1,115.79
Since filing the account no income has been received.
Since filing the account no disbursements have been made.
Since filing the account the following fees have been processed:
Fee for Period 6/1/2013 to 6/30/2013: $83.34
Final Tax Preparation Fee: $175.00
Final Accounting Fee: $50.00
Cumberland Filing Fee: $243.50
Leaving a balance for distribution of: 563.95
Which is distributed as follows:
Kelly Leigh Mellott 563.95