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HomeMy WebLinkAbout10-25-13 rnC-> t.1 2 TRUST M ° `-4 in c .n r— rn Cn cs _ 7;u COURT OF COMMON PLEAS OF ' CUMBERLAND COUN"T"Y,PENNSYLVANIA; ry r ro � ORPHANS' COURT DIVISION 4"s � c;l NAME OF TRUST (TRUST UNDER WILL OF___ or TRUST UAIDER DEED OF KATHYBASHORE SPECIAL NEEDS DATED 0812212013 ) No.J1- (3— 1B PETITION FOR ADJUDICATION 1 STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C.Rule 6.9 This form maybe used in all cases involving the Audit of Trust Accounts. If space is insufficient, riders may he attached. INCLUDEATTACHMENTSAT THE BACK OF THIS FORM. Name of Counsel: Mark A.Mateya Supreme Court I.D.No.: 78931 Name of Law Firm: Mateya Law Firm,P.C. Address: 55 W. Church Avenue, Carlisle,PA 17013 Telephone: 717-241-6500 Fax: 717-241-3099 Form oC-02 rev 10.13.06 Page I of 10 C& � r Name of Trust: Kathy Bashore Special Needs Trust 1. Name(s)and address(es) of Petitioner(s): Petitioner: Petitioner: Name: Pauline Neidigh Add,...., 738 Dellville Road Duncannon, PA 17020 2. Check if any of the following issues are involved in this case: A. Appointment of Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ B. Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ C. Discharge of Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ D. Transfer of Sims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ K. Williamson Issue* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ L. Other Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ . 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 settloddecedent's estate and received commissions in such capacity. Form oC-02 rev 10.13.06 Page 2 of 10 Name of Trust:Kathy Bashore Special Needs Trust 3. Testamentary Trust: Decedent's date of death: Date of Decedent's Will: Date(s) of Codicil(s): Date of probate: or Inter Vivos Trust: Date of Trust: 08/22/2013 Date(s) ofAmendment(s): 4. A. If any other Court has taken jurisdiction of any matter relating to this Trust, explain: B. Identify all prior accountings and provide dates of adjudication. None 5. A. State how each Trustee was appointed: Trustee,beneficiary and counsel determined together that Trustee was best suited. B. If a Petitioner is not a Trustee, explain: Form oc0z rev Io.13.06 Page 3 of 10 Name of Trust: Kathy Bashore Special Needs Trust 6. State how and when the present fund was awarded to Trustee(s): Fund was the result of an equitable distribution of marital funds;this was part of the Marriage Settlement Agreement. 7. Period covered by accounting: 12/13/2012 to September 30, 2013 8. Current fair market value of the Trust principal is $ 120,949.43 See page of Account.) 9. State concisely the dispositive provisions of the Trust: See Article II of the Trust document, attached. 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): First of required annual accountings. Form oC-02 rev 10.13.06 - Page 4 of 10 Name of Trust:Kathy Bashore Special Needs Trust 11. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit see Pa. O.C. Rule 12.4): A Petition for a Guardian Ad Litem has not been filed in this matter because the beneficiary is sui juris and is not a minor. 12. A. State the amount of Pennsylvania Transfer Inheritance Tax and Pennsylvania Estate Tax paid (including postponed tax on remainder interests),the dates of payment and the interests upon which such amounts were paid: Date Payment Interest d/n/a B. If any such taxes remain unpaid or are in dispute,explain: d/n/a 13. Describe any questions requiring Adjudication and state the position of Petitioner(s)and give details of any issues identified in item 2: The principal of the Trust may need to be invaded in an amount of less than$1,000.00 during the upcoming year;the expenditures are all for the benefit of the beneficiary and are all permissible expenditures of a special needs trust. Form oC-02 rev 10.13.06 Page 5 of 10 Name of Trust:Kathy Bashore 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); Ntztne and Address ofEach Party in Interest I Retationship and Comments ii any I Interest Special Needs Trust Depository Attn Manager,TPL Section PO Box 8486 Harrisburg, PA 17105 SSI Program Support Team Mid-Atlantic Program Service Center, 3rd& Spring Garden Street Philadelphia,PA 19101 Form OC-02-rev 10.13.06 Page 6 of 10 Name of Trust: Kathy Bashore Special Needs Trust Name and Address at Each Party in Interest I Relationship and Comments ifarry I Interest Max Byers Huntingdon Co Assistance Ofc 7591 Lake Raystown Shop Center Huntingdon PA 16652-0398 Kathy Bashore 940 Walnut Bottom Road Carlisle,PA 17015 B. Identify each parry who is not sui juris(e.g.,minors or incapacitated persons). For each such parry, 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 None C. If distribution is to be made to the personal representative of a deceased parry, state date of death, date and place of grant of Letters and type of Letters granted. d/n/a 16. If Petitioner(s)has/have knowledge that a Trust share has been assigned or attached, provide a copy of the assignment 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 10.73.06 Page 7 of 10 Name of Trust:Kathy Bashore Special Needs Trust B. If a principal commission is claimed, state amount. d/n/a 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 18. If a reserve is requested, state amount and purpose. Amount Purpose: 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 13 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 oC-02 rev 10.13.06 Page 8 of 10 Name of Trust: Kathy Bashore 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 Disolbutee(s) Amo"Wroportion Kathy Bashore 100% B. Principal: Proposed Distributee(s) AmountdProportion Kathy Bashore As necessary not to exceed $1,000.00 Submitted By: (All petitioners must sign. Add additional lines if necessary): Name of Petitioner: Pauline Neidigh FA u) i�� /V C- i� A- Name of Petitioner: Form oc-02 rev 10.13.06 Page 9 of 10 Name of Trust: Kathy Bashore Special Needs Trust Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that helm, She is eae Trustee of the above-named name ofcorporation Kathy Bashore Special Needs Trust and] 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). Signature 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. " � 'we�t Signature of Counsel for Petitioner For„,oC-oz rev 70.13.06 Page 10 of 10 FILE COP' Kathy Bashore Special Needs Trust Agreement This Trust Agreement is entered into by Pauline Neidigh,hereinafter referred to as "Settlor" and Pauline Neidigh, as Trustee (hereinafter referred to as"Trustee"). This Trust shall be known as "The Kathy Bashore Special Needs Trust"with an address of 738 Dellville Road, Duncannon, Pennsylvania 17020. ARTICLE I. TRUST ESTATE 1.01 Transfer to Trust. The Settlor will, upon the signing of this Trust Agreement and without consideration on Settlor's part, transfer and deliver to the Trustee the sum of twenty dollars ($10.00);receipt of which is acknowledged, and other certain assets which,together with the interest thereon, shall constitute the trust estate. The trust estate presently held,managed, administered, and distributed by the Trust as hereinafter provided for the sole benefit of Kathy Bashore,who presently resides at Manor Care Health Center, 940 Walnut Bottom Road Carlisle, PA 17015,hereinafter referred to as `Beneficiary". Kathy A. Bashore is a disabled individual as defined in §1382c(a)(3) of the Social Security Act. 1.02 Additions to Trust Estate. The Settlor, and any other person, shall have the right at any time to add property acceptable to the Trustee to this Trust and such property, when received and accepted by the Trust, shall become part of the trust estate, provided however,that no funds shall be placed in the trust after the beneficiary reaches the age of sixty-five (65) years unless authorized and appropriate under the then-existing law. 1.03 Successor Corporate Fiduciary. If any Bank or Trust Company ever succeeds.to the Trust business of a corporate fiduciary serving as a Trustee under this 1 Agreement,whether because of a name change, or any other form of reorganization, or if such corporate fiduciary ever transfers all of its existing business to any other Bank or Trust Company, the successor shall thereupon,without any action being required, succeed to the Trusteeship hereunder as if originally named. ARTICLE H. IRREVOCABILITY OF TRUST This Trust shall, irrespective of any legal presumption to the contrary, be irrevocable and shall not be altered, amended,revoked or terminated by any person except by the Trustee as (1) is permitted by law while retaining the irrevocable nature of this Trust, and(2) necessary to respond to (a)the requirements of an administrative agency with the authority to dispense public benefits or regulate this trust or trustee, or(b) changes in statutory, regulatory or case law, in order to fulfill the Settlor's intent to obtain maximum public benefits for the beneficiary and maximum legal protection of the assets of the Trust from invasion or assessment as set forth herein, including, but not limited to,the naming of additional contingent beneficiaries who would take their share after the payments made in Article IV have been made. This Trust is subject to the continuing jurisdiction of the relevant Orphan's Court of Common Pleas, including the Court's right to modify or terminate, for cause shown, although this Trust is otherwise irrevocable. ARTICLE III. DISTRIBUTION During the lifetime of the Beneficiary hereunder,the Trustee shall have the power to distribute or apply for the benefit of the beneficiary, such amount of(a) income (including accumulated income) without court approval, or(b) principal AFTER OBTAINING APPROVAL from the Orphans' Court Division of the Court of Common Pleas following due 2 notice to all interested parties including the Department of Public Welfare and Social Security Administration,as trustee may from time to time determine to be necessary or appropriate for the Beneficiary's special needs and comfort. Expenditures from the trust fund must have a reasonable relationship to the disability of the beneficiary. A copy of this Trust upon execution and any required notice to the Department of Public Welfare and Social Security Administration should be directed to: The special Needs Trust Depository Attention: Manager, TPL Section P.O. Box 8486 Harrisburg, PA 17105-8586 SSI Program Support Team Attention: Team Leader Mid-Atlantic Program Service Center 3`d & Spring Garden Streets Philadelphia; PA 19101 The Trustee shall act in its sole and absolute discretion(subject to provision of this Trust, the obligations of law and the supervision of the Court), and shall make distributions after considering federal, state, or local entitlements,programs or other benefits; provided however, that such applications of principal and/or income shall be to the extent not suitable provided for by insurance or by federal, state, or local entitlements,programs, or other benefits of any nature whatsoever and further provided that such application of principal and/or income shall be made for the sole benefit of the beneficiary an in such a manner as to meet the special needs of the Beneficiary while seeking to maximize the Beneficiary's eligibility for such federal, state, and local entitlements, programs, or other benefits of any nature whatsoever. It is the intent of the Settlor to maintain the highest degree of federal, state, or local entitlements, programs and other 3 benefits for the Beneficiary at public expense while seeking to fulfill the special needs of the beneficiary, and to protect principal and income of this Trust from invasion or assessment by any federal, state, or local governmental or other agency or insurance company or provider of publicly-funded services for reimbursement during the lifetime of the beneficiary, for(or the provision of) monies, services, or assistance of any kind which has been, or will be, expended upon or provided to the Beneficiary herein. Special needs shall mean those requisite items, products or services that can be provided to the beneficiary to assist in the management, care or treatment of the beneficiary's disability and increase the beneficiary's quality of life. Special needs shall include but not be limited to medical expenses, dental expenses, nursing and custodial care, psychiatric/psychological services, recreational therapy, occupational therapy,physical therapy, vocational therapy, durable medical needs,prosthetic devices, special rehabilitative services or equipment,programs of training, education, transportation(including the purchase of an accessible/adapted vehicle) and required travel expenses, telephonic equipment, cable television and internet access as directly related to the disability, dietary needs and supplements,professional expenses, insurance costs, architectural modifications to permit access to a residence, and the purchase in the name of the Trust of appropriate housing for the beneficiary, together with costs of repair and maintenance. The provisions of this Article are to be read in conjunction with the rights of providers of services/entitlements set forth in Article IV to recover assets for repayment to the extent mandated by statute,regulation, or judicial decision., If ordered by the Court, the Trustee shall provide the Commonwealth of Pennsylvania with an informal accounting of the receipt and 4 distribution of income on an annual basis. Trustee may, in its sole and absolute discretion, engage from time to time any individual, corporation,partnership or other entity to render services to Trustee in guiding its discretionary distributions pursuant to any standard for distribution set forth in the preceding paragraph of this Article III. Trustee shall not be liable for reasonably relying upon the advice of any consultant whom it is reasonable to retain. Trustee may pay for any such consulting services from the income or principal of the trust estate,without reduction for any compensation paid to Trustee for its services as Trustee. ARTICLE IV. TERMINATION OF TRUST AND DISTRIBUTION OF PRINCIPAL A. Upon termination of this Trust as set forth herein,the trustee shall first notify the COMMONWEALTH OF PENNSYLVANIA and reimburse the COMMONWEALTH OF PENNSYLVANIA and any other government entity for any unpaid valid lien for medical assistance provided to Beneficiary to the extent, and only to the extent, as required by section 1396p(d)(4)(A) of Title 42 of the United States Code or any successor statute from assets remaining in this Trust at that time. IN THE EVENT that more than just the Commonwealth of Pennsylvania is entitled to reimbursement for Medicaid expenditures, each state shall receive its proportionate share of the total amount of Medicaid to be reimbursed. B. If the Trustee determines that it is impractical to administer the Trust held under this irrevocable Trust because it is or becomes too small to justify maintaining a trust, or because it is no longer suitable for the Beneficiary's needs, the Trustee may terminate this Trust and 5 F shall, after making any reimbursement to the Commonwealth required under this Article, distribute the principal and income of the Trust as ordered by the court if the Beneficiary is'a minor or incapacitated person, and otherwise to the Beneficiary outright. C. This Trust shall also terminate upon the earlier of the following occurrences: (1) The death of the Beneficiary, or (2) A determination by the Trustee that a bona fide attempt(as determined solely by the Trustee)has been made to cause the successful and significant invasion of, or assessment upon, either the principal or interest of this Trust by any federal, state, or local governmental agency or insurance company or provider of publicly-funded services or entitlements. Any portion of the trust estate remaining after reimbursement to the Commonwealth required under this Article, shall be paid to the children of Kathy Bashore, per stirpes, in shares as nearly equal as possible. If a contingent or subsequent beneficiary should then be disabled, incapacitated, or a minor, the Trustee shall hold and distribute said share for said beneficiary in accord with the terms of this Trust or as directed by a court of competent jurisdiction. ARTICLE V. POWERS OF TRUSTEE Description of Powers. In order to carry out the purposes of this Trust Agreement, the Trustee, in addition to all other powers granted by law from time to time, shall have the following powers: Retention of Assets (1) To retain any property received by the trust estate for as long as the Trustee considers it advisable. 6 Investments (2) To retain and invest in all forms of real and personal property in accordance with and as authorized by the Prudent Investor Rule,20 Pa. C.S.A. 7201 et. se q. as amended from time to time (provided however,that the corporate trustee may not receive duplicate investment advisory compensation- i.e., both trustee fees and mutual fund advisory fees, as a result of its investments in its own affiliated mutual funds,unless prior approval is obtained from the Orphans' Court), and to invest in any other property and investments,including real estate. Management (3) To manage, control,repair, and improve all trust property,real or personal. Sales (4) To sell, for cash or on such terms and conditions as deemed advisable or desirable by the Trustee,and to exchange any trust property. Adjustment of Claims (5) To adjust or compromise any claims for or against the trust,and to agree to any rescission or modification of any contract or agreement. Borrowine (6) To borrow money and to mortgage or pledge or otherwise encumber or hypothecate trust assets as the Trustee may, in its discretion, deem advisable. (7) To purchase as an investment for this Trust any assets of an estate or estates, provided that the price paid for such assets shall not exceed the fair market value thereof, and to make loans to the Settler's estate or estates at a fair rate of interest and with adequate security; and to continue to hold assets so purchased or loans so made as investments hereunder. 7 Limitation on Powers (8) All powers given to the Trustee by this Trust Agreement are exercisable by the Trustee only in a fiduciary capacity. No power given to the Trustee hereunder shall be construed to enable the Settlor or any person to purchase, exchange, or otherwise deal with or dispose of the principal or income therefrom for less than an adequate consideration in money or money's worth; or to authorize loans to a legal person except on the basis of an adequate interest charge and with adequate security. No person, other than the Trustee, shall have or exercise the power to vote or direct the voting of any corporate shares or other securities of this Trust, to control the investments of this Trust either by directing investments or reinvestments or by vetoing proposed investments or reinvestments, or to re-acquire or exchange any property of this Trust by substituting other property of equivalent value. Good Faith Reliance (9) Until actual receipt of written notice of any death, birth or other event upon which the right to receive income or principal under this Trust Agreement may depend, to make distributions in good faith free of liability to persons whose interests have been affected by that event. Options (10) To exercise any options, rights and privileges available to or acquired by Trustee for the purchase of any assets. Lease (11) To lease for any term, exchange or sell at public or private sale any trust assets and grant option to lease for any term, exchange or purchase any trust assets, in each case 8 without Court Order. Nominee Name (12) To hold investments in bearer form, or register them in Trustee's name or in the name of its nominee. Subscription Rights (13) To subscribe for stock and bond privileges, give proxies,join in any merger, reorganization or voting trust with respect to investments under this Trust Agreement, and vote or refrain from voting any securities. Distribution (14) To make distribution under this Trust Agreement in cash, in kind or partly in each. Taxes (15) To pay any taxes, interest and/or penalties and to apply for and collect any tax refunds and interest incurred. Estate Payments (16) After the payments set forth in Article IV, the Trustee may make such payment from the principal of the trust estate as Trustee may think desirable to facilitate the settlement of Beneficiary's estate, and in the exercise of this power Trustee may pay in whole or in part, any or all of(I) the expenses of Beneficiary's funeral,burial and grave marker, and(ii)taxes and administration expenses of Beneficiary's estate, even though they do not relate to any property becoming subject to this Trust Agreement. Neither any personal representative nor any 9 beneficiary of Beneficiary's estate should be required to reimburse the Trustee for any such expenditures. Real Estate (17) Trustee may conduct any prudent real estate transaction. Trustee shall not be deemed to have accepted title to, and shall not act or be obligated to act in any way as a fiduciary with respect to, any commercial real property, including any real property owned or operated by ,a sole proprietorship, general or limited partnership, limited liability company, or closely held corporation, or any interest in any such business enterprise,which is or may become an asset of the Trust until (I) an appropriate environmental audit is performed at the expense of the donor, or the Trust(or expressly waived in writing by the Trustee)to determine that conditions at such real property or operations conducted by such business enterprise are in compliance with state and federal environmental laws and regulations affecting such real property or such business enterprise and(ii) Trustee has accepted such property as an asset of the Trust by written acceptance given to the donor of the property in question, or if none, to the income beneficiary or beneficiaries of the Trust(or their natural or legal guardian). Should any environmental hazard be discovered, income or principal may be used to cure such hazard. (18) Trustee may pay,in whole or in part for the establishment of a reasonable, irrevocable.burial reserve and/or burial fund for the expenses of Beneficiary's funeral, burial or grave marker. Authority to Amend Trust (19) In accordance with the provisions of Article II, the Trustee may amend this Agreement so that it conforms to federal and state law, including related statutes,regulations and 10 policies, governing governmental programs for which the Beneficiary is eligible, including,but not limited to,Medicaid and Supplemental Security Income (SSI). ARTICLE VI. DUTIES AND COMPENSATION OF THE TRUSTEE (1) Allocation of Income and Principal. The Trustee shall determine what is income and what is principal of the Trust created under this Trust Agreement, and what expenses, costs, taxes, and charges of any kind whatsoever shall be charged against income and what shall be charged against principal in accordance with the applicable statutes of the United States and the Commonwealth of Pennsylvania as they now exist and may from time to time be amended. (2) Relations with Trustee. No one dealing with the Trustee need inquire concerning the validity of anything the Trustee purports to do, or need confirm the application of any money paid or any property transferred to or on the order of the Trustee. (3) Limitation on Trustee's Liability. No Trustee appointed under this Trust Agreement shall at any time be held liable for any act or failure to act or any act or failure to act of its agent or of any other person in connection with the administration of the trust estate,unless caused by Trustee's gross negligence or by a willful commission of an act in breach of trust. (4) Compensation. The original Trustee or any successor Trustee named herein may retain from the trust estate from time to time those fees which are consistent with its standard schedule of fees in effect for work as a corporate fiduciary over the period during which services are rendered. (5) Bond. No bond shall be required of the original Trustee hereunder or of any successor Trustee; or if a bond is required by law, no surety shall be required on such bond. 11 (6) Successor Trustee. If the trustee named above should be unable or unwilling to serve,the Settlor(or, if the Settlor is deceased or incapacitated,the Guardian of the Estate of the Beneficiary) may appoint another licensed corporate fiduciary to act as successor trustee. A Trust may resign by giving written notice to the Settlor or a Guardian of the Estate of the Beneficiary, in a signed and acknowledged instrument. If no Settlor or Guardian is readily available, a Trustee or successor Trustee may name a successor Trustee in writing, delivered to, and following consultation with, outside counsel to the Trust and the Beneficiary. When the term"Trustee"is used in this document, it also includes anyone serving as a successor trustee. In the event that a beneficiary or a legal guardian of a beneficiary should believe that it is not in the best interests of a beneficiary for the trustee to continue to serve as trustee, a beneficiary or a legal guardian of the beneficiary may request the Court of Common Pleas to appoint a successor trustee to serve as trustee. The Trustee may,but shall not absent an order of Court be required to, prepare and file accountings for any Court with notice to the Department of Public Welfare. Prior to delivering all of the property of any trust hereunder to a successor Trustee or the making of any partial or complete distributions of Trust principal, the Trustee may require an approval of this accounting either by a release in discharge by the Beneficiary or beneficiaries of any such Trust or by a Court of competent jurisdiction. ARTICLE VII. SPENDTHRIFT PROVISION The interests, if any, of a beneficiary in the principal or income of this Trust shall not be subject to the claims of his/her creditors, or creditors of others, including creditors of any spouse 12 S of a married beneficiary, nor to legal process, and may not be voluntarily or involuntarily alienated or encumbered. ARTICLE VIII. CONSTRUCTION OF TRUST (1) Governing Law. This trust shall be governed by the laws of the Commonwealth of Pennsylvania. (2) Copies. To the same extent as if it were the original, anyone may rely on a copy of this Trust certified by a notary public to be a true copy of this Trust. Anyone may rely on any statement of fact certified by anyone who appears from the original Trust Agreement or a certified copy thereof to be a Trustee hereunder. IN WITNESS WHEREOF,this Trust Agreement has been signed by the Settlor and the Trustee on this 2Z day of ko U j 2013. SETTLOR: Witness Pauline Neidigh TRUSTEE: Witness Pauline Neidigh 13 ol - 13 Kathy Bashore Special Needs Trust Pauline Neidi , Trustee Initial Accounting and Proposed Expenditures for Upcoming Year This is the initial accounting of the Kathy Bashore Special Needs Trust (hereinafter the trust) by trustee, Pauline Neidigh. The trust was created on August 22, 2013. The trust has been accepted by the Social Security Administration, the Department of Public Welfare, and is duly registered with The special Needs Trust Depository Attention: Manager, TPL Section c ,� f:., m P.O. Box 8486 n r- -y !� 7r t- fV Harrisburg, PA 17105-8586 `r' � and SSI Program Support Team " a Mid-Atlantic Program Service Center <n 3rd & Spring Garden Streets Philadelphia, PA 19101. I. Real Property The trust presently contains no real estate. No real property has been; or is anticipated to be, a part of this trust. 1I. Personal Property The original trust corpus came from funds generated from by the equitable distribution of the marital estate of Kathy Bashore and her ex-spouse, Joseph G. Bashore. The original deposit was in the amount of$121,584.88. This amount was separated into a savings of$111,584.88 and a checking of$10,000.00. Page 1 of 4 Expenditures from Citizens Bank Trust Checking Account inception to date: 12/13/2012 Service Charge $10.00 1/31/2013 Monthly Service Charge $ 2.00 2/7/13 Mateya Law Firm - #991 $250.00 2/28/13 Monthly Service Charge $ 2.00 3/29/13 Monthly Service Charge $ 2.00 4/30/13 Monthly Service Charge $ 2.00 5/17/13 #992 Verizon Wireless $ 53.00 5/30/13 #993 Verizon Wireless $ 92.82 5/30/13 Checks printed charge $ 58.04 5/31/13 Monthly Service Charge $ 2.00 6/28/13 Monthly Service Charge $ 2.00 7/1/13 Verizon Wireless - #1001 $ 49.20 7/30/13 Verizon Wireless #1003 $ 50.07 7/31/13 Monthly Service Charge $ 2.00 8/30/13 Monthly Service Charge $ 2.00 9/04/13 Verizon Wireless- #1004 $ 48.58 9/12/13 Mateya Law Firm - #1005 $400.00 9/30/13 Monthly Service Charge $ 2.00 No interest was earned in the Citizens Bank checking account. Interest earned in the Citizens Bank Savings Account. 12/31/2012 Interest earned $37.65 1/31/2013 Interest earned $61.62 2/28/13 Interest earned $55.69 3/29/13 Interest earned $61.69 4/30/13 Interest earned $36.76 5/31/13 Interest earned $37.99 6/28/13 Interest earned $36.78 7/31/13 Interest earned $38.02 8/31/13 Interest earned $14.26 9/30/13 Interest earned $13.80 Page 2 of 4 Y Account Current Amount Citizens Bank Checking: $ 8,970.29 Citizens Bank Savings: $111,979.14 III. Proposed Expenses for next twelve months Trustee anticipates spending not to exceed $2,000.00 in the next twelve months, plus counsel fees, which should not exceed $750.00. Expenditures will be for beneficiary's phone and personal items, including personal assistance and appropriate gifts (birthday and Christmas) for the beneficiary. Page 3 of 4 Verification of Petitioner The undersigned hereby verifies that she is trustee of the above-named Kathy Bahsore Special Needs Trust and that the facts set forth in the foregoing Initial Accounting and Proposed Expenditures for Upcoming Year 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). Pauline Neidigh Certification of Counsel The undersigned counsel hereby certifies that the foregoing Inventory statement is a true and accurate statement, and that no changes to the form have been made beyond the responses herein. Mark A. Mateya CitizCitizens Bank Commercial Account ens Statement 1-800-862-6200 © or 2 Call citizens'Phone8ank anytime for account information, current rates and answers to your questions. Beginning December 13,2012 US102 BR289 through December 31,2012 . KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance .00 Business Green Checking Checks .00 - 623183-483-6 Debits 10.00 - Deposits&Credits 10,000.00 + Current Balance 9,990.00 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in your account of$2,000 or making 5 qualifying transactions. Your average daily balance used to qualify this statement period is: $9,999 Your number of qualifying transactions this statement period is: 0 Previous Balance TRANSACTION DETAILS .00 Debits Other Debits Date Amount Description 12/31 10.00 Service Charge(1) Cash Dep/Currency Orders $10,000-$5,000 Free $10.00 Total De&its 10.00 Deposits&Credits Date Amount Dewription 12/13 10,000.00 Deposit � Total Deposits&Credits 10,000.00 I 71 Current Balance Daily Balance 9,990.00 Date Balance Date Balance Date Balance 12/13 10,000.00 12/31 9,990.00 NEWS FROM CITIZENS --NOTICE: By federal law,as of 1/1/2013,funds in a noninterest-bearing transaction account (including an IOLTA/I OLA)will no longer receive unlimited deposit insurance coverage,but will be FDIC-insured to the legal maximum of$250,000 for each ownership category.For more information visit:http://www.fdic.gov/deposit/deposits/unlimited/expiration.html --Rethink What a Business Credit Card Can Do. accessCARD Command(TM)is an exciting innovation in Business Credit Cards-only from Citizens Bank.accessCARD Command puts YOU in control of when,where and how employees' Citizens Bank Commercial Account Statement 1-800-862-6200 © answers to your quest of 2 Call Citizens'Phonel3ank anytime for account information, current rates and anions. Beginning December 13,2012 through December 31,2012 Commercial Checking continue0/rom previous page KATHY BASHORE NEWS FROM CITIZENS(continued) SPECIAL NEEDS TRUST cards may be used.Set spending limits based on transaction by dollar amount,category, PAULI NE G NEI DIGH TRUSTEE merchant type and geography;customized for each employee;receive email and text alerts when limits you have set have been exceeded;create virtual card numbers for safer online and phone Business Green Checking purchases.It's free&easy to set up.Apply today for an Everyday Points Business MasterCard 623183-483-6 or Business Platinum MasterCard,both with accessCARD Command.Call us at 1-888-203-5956. Business Credit Card offer is not available for international clients. k'.tv'rBti L� Fa�l�bo9ng larnln: Citizens Bank Commercial Account �11R� Statement 1-800-862-6200 O OF 1 Call Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning January 01,2013 US102 BR289 through January 31,2013 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 9,990.00 Business Green Checking Checks .00 - 623183-483-6 Debits 2.00 - Deposits&Credits .00 + Current Balance 9,988.00 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in your account of$2,000 or making 5 qualifying transactions. Your average dai ly balance used to qualify this statement period is: $9,989 Your number of qualifying transactions this statement period is: 0 Previous Balance TRANSACTION DETAILS 9,990.00 Debits Other Debits Date Amount Description 01/31 2.00 Service Charge(1) Statement Delivery ^ !—\ Total Debits 2.00 —, Current Balance Daily Balance 9,988.00 Date Balance Date Balance Date Balance 01/31 9,988.00 41ea;52 FLL Q e,i.e;H>usg tt<mz- . Citizens Bank Commercial Account Bank Statement 1-800-862-6200 O DP 1 Call Citizens'PhoneBank anytime for account information, Current rates and answers to your questions. Beginning February 01,2013 US1O2 BR289 through February 28,2013 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 9,988.00 Business Green Checking Checks 250.00 - 623183-483-6 Debits 2.00 - Deposits&Credits .00 + Current Balance 9,736.00 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in your account of$2,000 or making 5 qualifying transactions. Your average daily balance used to qualify this statement period is: $9,791 Your number of qualifying transactions this statement period is: 1 - Previous Balance TRANSACTION DETAILS 9,988.00 Checks'There is a break in checksequence check# Amount Date Check# Amount Date 991 250.00 02107 n " Total Checks 250.00 Debits Other Debits Data Amount Description 02/28 2.00 ServiceCharge(1) Statement Delivery n Total Debits 2.00 /-1 Current Balance 'Daily Balance 9,736 00 Dale Balance Date Balance Date Balance 02/07 9,738.00 02/28 9,736.00 _ A'.m:['.:rJ!i LJ 2gds114oirB tnde- Citizens Bank Commercial Account Bank Statement 1-800-862-6200 O OF 1 Ca II Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning March 01,2013 US102 BR289 through March 31,2013 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 9,736.00 Business Green Checking Checks .00 - 623183-483-6 Debits 2.00 - Deposits&Credits .00 . Current Balance 9,734.00 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in your account of$2,000 or making 5 qualifying transactions. Your average daily balance used to qual ify this statement period is: $9,735 Your number of qualifying transactions this statement period is: 0 Preaiuus Balance TRANSACTION DETAILS 9,736.00 Debits Other Debits Date Amount Description 03/29 2.00 Service Charge(1) Statement Delivery Total Debits 2.00 n Current Balance Daily Balance 9,734.00 new Balance Date Balance Date Balance 03/29 9,734.00 N.-aixr FUC EgnitpmeaB_az:m Citizens Bank Commercial Account �a 1l.. K Statement 1-600-662-6200 Q OF 1 Call Citizens'Plmnesank anytime f�accou it incarm3tion, cvrwa,ates and answers w your questions, Beginning April 01,2013 through April 30,2013 US102 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9766 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation r, SPECIAL NEEDS TRUST PAULINE G NEI DIGH TRUSTEE Previous Balance 9,734.00 Business Green Checking Checks .00 - 823183-483-8 Debits 2.00 - Deposits&Credits .00 + _ Current Balance 9,732.00 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in your account of$2,000 or making 5 qua ifying transactions. Your average daily balance used to qualify this statement period is: $9,733 Your number of qualifying transactions this statement period is: 0 Previous Balance TRANSACTION DETAILS 9,734.00 Debits Other Debits Data Amount Description 04/30 2.00 Service Charge(1) Statement Delivery Tatal Debits 2.00 Current Balance Daily Balance 9,732.00 Date Balance Date Balance Date Balance 04/30 9,732.00 Citizens Bank Commercial Account Statement 1-800-862-6200 O OF 2 cal citizens'Phoneliank anytime for account information, current rates and answers to your questions, Beginning May 01,2013 US102 BR289 through May 31,2013 KATHY BASHORE SPECIAL NEEDS TRUST - PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation - SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 9,732.00 Business Green Checking Checks 145.82 - 623183-483-6 Debits 60.04 - Deposits&Credits .00 + Current Balance 9,526.14 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in your account of$2,000 or making 5 qualifying transactions. Your average dai ly balance used to qualify this statement period is: $9,696 Your number of qualifying transactions this statement period is: 3 Previous Balance TRANSACTION DETAILS 9,732.00 Checks*There is a break in checksequence Cheek# Amount Date Check# Amount Date 992 53.00 05/17 993 92.82 05/30 _ n Total Checks 145.82 Debits Other Debits Date Amount Description 05/30 58.04 Dlx For Business Bus Prod 130529 02027764987128 .05/31 2.00 Service Charge(1) Statement Delivery Tool Debits 60.04 Current Balance Daily Balance 9,526.14 Date Balance Date Balance Date Balance 05/17 9,679.00 05/30 9,528.14 05/31 9,526.14 NEWS FROM CITIZENS --This notification is provided to you as.a reminder that in accordance with the Unlawful Internet Gambling Enforcement Act of 2006,(the"Act')and other applicable federal and state laws,along with bank policy and the terms of your Deposit Account Agreement with us,you have agreed not to engage in the transaction of business involving Internet gambling, knowingly accepting payments from any person or entity in connection with Internet gambling, or any other restricted transactions(collectively"restricted transactions"). Under the Act, .,..._.rf D:c Li Citizens Bank Commercial Account Statement 1-800-862-6200 I© or 2 Call Citizens'Phone lank anytime for account information, current rates and answers to your questions. Beginning May Ot,2013 through May 31,2013 Commercial Checking continued from previous page KATHY BASHORE NEWS FROM CITIZENS(continued) SPECIAL NEEDS TRUST unlawful Internet gambling generally would cover making abet or wager that involves use of PAULINE G NEIDIGH TRUSTEE the Internet without licensing.We reserve the right o prevent or prohibit he acceptance Business Green Checking or payment of such restricted transactions through any means,including the use of automated clearinghouse transact ions,card systems,check collection or wire transfers. Intheevent 623183-483-6 we find you to be engaging in any restricted transactions,we reserve the right to take action,as we deem appropriate,including but not limited to,the immediate closure of your account. Under applicable law,regulations and bank policy,we also reserve the right to identify and block,or otherwise prevent or prohibit such restricted transactions and any other transactions that may relate to Internet gambling businesses. mrt..r;DEG Q[pxtl w�mu�.aanr � � � Commercial Account i 1 Statement t _800-862}6200 0 OF 1 .Call Citizens:PhdneBank anytime fe accoupt information, 'current rates and answers to youi,questionsS,n dalrin -....,...:..*.... .-"•��* Beginning June 01,2013 1"thwjKJune 304013' - ,YS102.$R289 ,KATHYfBASHORE SPEGIAL1-NEEDS .y-RUST FAULINE+G .NE I D I.GH TRUSTEE ;738`.D�ELLVA LLE �RD- s FE. DUNCANNON "PA 1�7.020-,9,7,68 .....w,,. _. + bs 1 ,�<nw �r r6r• r'Commercial,Ch king_ t� sumxlpav . ... . . .._. _ _._.. _.._ _. . __,..._._. _,__.. ... ._ r ._ KATHY�BASHORE W...._ . .._ ._. SPECIALNEEDS TRUST p;Balance Calculation ;r�-U ^+r;rn^'+- '- ' PAULINEGNEI DIGHTRUSTEE ;Previous Balance 9,526.14 3-' { i essGreen racking Business Green Checking'' Checks - - .v.00 - 623183=483-6 ' g „Debits 2..00 - t.:`;+t;'' "6,1 • Deposits&Credits 00 + ;Current Balance 9,524.14 = _. g rYou'can waive the monthly maintenance fee of.$9.99 by maintaining an average daily balance inI. i youraccountof$2�000ormaking5qualifyingtransactions' --9f "�'?"`^� ^�'t '•" Your aDeragedaily balance used toqualifythis Statement period is: $9,525 ,,,Yo number of qualifying transactions this statement period'is: S9 4" 0 A,f Previous Balance - ,,,TRANSACTION DETAILS rkaD,ebits' - ty,OthertDebits Date Amount Description -, 06/28 Z.00 Servlce„Charge(1) ,_.. .,T*_,; - ' Statefnent De 4Wery - _ Total ebits 2.00 Current Balance ._ . � y^ ......... .... .. . .... ':'.9;524.14 -Daily Balance Date Balance Date Balance Date Balance 06/28 9,524.14 I i ttrp;p¢!S;CIG�eFV!ikes:,q!�mis- I ;Y INC 4 a'AKN P14V,rA i N I i R T eugT l03.,M .Sid: �,SJ4'� •tP5iL,t t �`i '�:+7i;{54Czi4'ttsg? 4. t 1 hfJV p fA- Cd,.`. rseV.r9 sid;•.TCarx_ n?ss'Graf-r!��-n.:r�g 'rafr,:r«g+t,�ryir;ln-s Ts pd,2q.e?!au ai r;'�- r� .zl C�;!rx*t?!ar'nz sixav#s�:r;n�{,%r»x, ,x '.�S�.i!a e,^-,.-.;rs::•, kp,Y.A;§CtX1pKi f :Tleaf`�z4°U { t. T }`x wa's.9 exit/ !ran daiT or ; as vkI '",(. 'i!vf•, tnvo 5C1.Dr3,{; `s t 71 dc Citizens Bank 1-800-862-6200 Co mr eFcr��F�counl222013 P.O.Box 7000 Call Citizens'PhoneBank anytime for Statement ROP450 account information,current mfrs and Providence,RI 02940 answers to your questions. © or 1 Beginning September 01,2013 . through September 30, 2013 AT 01 12169T 1830OB357 A"3DGT I�IIIrIrII��rJI"�I��III'III"IIII�IIII��rl�d�lll��'�"�'Ilell� KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DONCANNON PA 17020-9768 Commercial Checking US102 SUMMARY KATHY BASHORE Balance Calculation SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 9,420.87 - Business Green Checking Checks 400.00 - XXXXXXX483-6 Debits 50.58 - Deposits&Credits .00 + Current Balance 8,970.29 = You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in — your account of$2,000 or making 5 qualifying transactions. Your average daily balance used to qualify this statement period is: $9,123 Your number of qualifying transactions this statement period is: 2 -_ Previous Balance TRANSACTION DETAILS 9,420.87 _ Checks`There is a break in check sequence Check B Amount Date Check B Amount Date 1005 400.00 09/12 n Total Checks 400.00 Debits Other Debits Date Amount Description 09/04 48.58 Verixon Wireless Payment 130903 09/30 2.00 Check ft Change(1)a4 Statement Delivery n Total Debits 50.58 f—1 Current Balance Daily Balance _ 8,970.29 Date Balance Date Balance Date Balance 09/04 9,372.29 09112 8,972.29 09/30 8,970.29 Memhe,FplC rsr ETya HOUSinO LenEer Alt E Account Bank State ment 1-800-862-6200 0 Of 2 Ca it Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning December 13,2012 through December 31,2012 US102 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEiDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUSI PAULINE G NEIDIGH TRUSTEE Previous Balance .00 Average Daily Balance 111,584,88 Business Motley Market Savings Checks .00 - Interest 623183-482-8 Debits .Op - Deposits&Credits 111,584.88 + Current Interest Rate .65% _ Interest Paid 37.65 + Annual Percentage Yiefifained .65% Current Balance 111,622.53 = Number of Days Interest Earned 19 Interest Earned 37.65 Interest Paid this Year 37.65 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to qualify this statement period is: $111,584 PreaiW5ad1aM4 00 TRANSACTION DETAILS Deposits&Credits Date Ammmt Description 12/13 111,584.88 Deposit rt Tatat Deposits&Credits T 111,584 88 Interest Date Amount Description 12/31 37.65 Interest Total Interest Paid 37.65 Current 9annce 111,622.53 Daily Balance Date Balance Data aalcumm Date 9alance 12/13 111,584.86 12/31 111,622.53 NEWS FROM CITIZENS --NOTICE: By federal law,as of 1/l/2013,funds in a nonintefest-bearing transaction account (including an iOLTA/IOLA)will no longer receive unlimited deposit insurance coverage,but will be FDIC-insured to the legal maximum of$250,000 for each ownership category.For more information visit:http://www,fdic.gov/deposit/deposits/unlimited/expiration,html --Rethink What a Business Credit Card Can Do. accessCARD Command(TM)is an exciting innovation in Business Credit Cards-only from Citizens Bank.acces.ssCAARD Command puts YOU in control of when,where and how employees' keny.:V�La �slyfianL-96A1L^• Commercial tateme ialAccount Citizens Bark Statement 1-800.862-6200 © OF 2 Cali Citizens'PhoneEank anytime for account information, current rates and anw.rs to your questions. 2012 Beginning December 13, through December 31,2012 Cmnmerciat Ctarckirg car#imm0 hmn rxeviaut KATHY BASHORE NEWS FROM C ITI ZEN$(continued) SPECIAL.NEEDS TRUST cards may be used.Set spending limits based on transaction by dollar amount,category, PAULINE G NEIDIGH TRUSTEE merchant type and geography;customized for each employee;receive email and text alerts when Business Money Market Savings limits you have set have been exceeded;create virtual card numbers for safer online and phone purchases,It's free&easy to set up.Apply today for an Everyday Points Business MasterCard 623183-482-8 or Business Platinum MasterCard,both with accessCARD Command.Call us at 1-888-203-5956. Business Credit Card offer is not available for international clients. Citizens Bank Commercial Account Statement 1-800-862-6200 © or 1 Call Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning January 01,2013 through January 31,2013 US1O2 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY - KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 111,622.53 Average Daily Balance 111,622.53 Business Money Market Savings Checks .00 - 623183-482-8 Debits .00 - Interest Deposits&Credits .00 + Current Interest Rate .65% _ Interest Paid 61.62 + Annual Percentage Yield Earned .65% Current Balance 111,684.15 = Number or Days Interest Earned 31 Interest Earned 61.62 Interest Paid this Year 61.62 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to qualify this statement period is: $111,622 Previous Balance TRANSACTION DETAILS 111,622.53 Interest Date Amount Description 01/31 61.62 Interest ^ Tool Interest Paid 1 61.62 n Current Balance Daily Balance 111,684.15 Date Balance Date Balance Dale Balance 01/31 111,684.15 Y,-,FCIG L—J lquxl l4.in5 tae N_ All; Citizens Bank Commercial Account Statement IE 1-800-862-6200 O OF 1 Cal l Citizens'Ph oneBank anytime for account information, current rates and answers to your questions. Beginning March 01,2013 through March 31,2013 US1O2 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 111,739.84 Average Daily Balance 111,739.64 Business Money Market Savings Checks .00 - Interest 623183-482-8 Debits .00 - Deposits&Credits .00 + Current Interest Rate .65% _ Interest Paid 61.69 + Annual Percentage Yield Earned .65% Current Balance 111,801.53 = Number of Days Interest Earned 31 Interest Earned 61.69 Interest Paid this Year 179.00 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum dai ly balance used to qual ify this statement period is: $111,739 Previous Balance TRANSACTION DETAILS 111,739.84 Interest Data Amount Description 03/29 61.69 Interest n + Total Interest Paid 61.69 n Current Balance Dai ly Balance 111,801.53 Date Balance Date Balance Date Balance 03/29 111,801.53 hfeni+x fiffi;1J [.Fnl M.vz'v5:,:wr Commercial Account Citizens Bank Statement 1-800-862-6200 © of 1 can Cnlzens'Phooesank anytimefaraccowu inramation, current rates and answers to your quest uns. Beginning February 01,2013 through February 28,2013 US102 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE O NEIDIOH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9788 Commercial Checking SUMMARY KATHY BASHORE SPECIAL NEEDS TRUST Balance Calculation balance PAULINE G WEIGH TRUSTEE Previous Balance 111,684,15 Average Daily Balance 111,684.15 Business Money Market Savings Checks AO - interest 623183-482-8 Debits 00 - Deposits&Credits ,00 + Current Interest Rate .65% _ Interest Paid 55.69 + Annual Percentage Yield Earned .65% Current Balance 111,739,84 = Number of Days Interest Earned 28 Interest Earned 55.69 Interest Paid this Year 117.31 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to qual ify this statement period is: $111,684 MeviousBalance 111,684.15 TRANSACTION DETAILS Interest Date Amount Description 02128 55.69 Interest Tntaloterest pa fa v— SS.69 f1 Current9alence E 111,739.84 Daily Balance Date Balance Data Balance Date Balance 02728 111,739.84 a.ers*:uw�'rw�!anaaq Lm�' Citizens Bank Commercial Account Statement Alm 1-800-862-6200 O OF 1 Call Citizen PhoneBank anytime for account information, current rates and answers to your questions. Beginning April 01,2013 through April 30,2013 US102 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE SPECIAL NEEDS TRUST Balance Calculation Balance PAULI NE G NEIDIGH TRUSTEE Previous Balance 111,801.53 Average Daily Balance 111,801.53 Business Money Market Savings Checks .00 Interest 623183-482-8 Debits .00 - Deposits&Credits .00 + Current Interest Rate .40% Interest Paid 36.76 + Annual Percentage Yield Earned .40% Current Balance 111,838,29 = Number of Days Interest Earned 30 Interest Earned 36.76 Interest Paid this Year 215.76 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum dai ly balance in your account of$5,000. Your minimum daily balance used to qual ify this statement period is: $111,801 Previous Balance 111,801.53 TRANSACTION DETAILS Interest Date Amount Description 04/30 36.76 Interest ^ Total Interest Paid 1 36.76 nCurrent Balance 111,838.29 Daily Balance Date Balance Date Balance Date Balance 04/30 111,838.29 MEMO --The APY for your Money Market account on this statement is your current APY,which is a variable rate and subject to change at any time. u.m:x logic 1=T rsun+.,sm:�*� AStatement � Citizens Bank Commercial Account 1-600-662-6200 © OF 2 Call Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning May 01,2013 through May 31,2013 US102 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 111,838.29 Average Daily Balance 111,838.29 Business Money Market Savings Checks .00 - Interest 623183-482-8 Debits .00 - Deposits&Credits .00 + Current Interest Rate .40% _ Interest Paid 37.99 + Annual Percentage Yield Earned .40% Current Balance 111,876.28 = Number of Days Interest Earned 31 Interest Earned 37.99 Interest Paid this Year - 253.75 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to qual ify this statement period is: $111,838 Previous Balance TRANSACTION DETAILS 111,838.29 Interest Date Amount Description 05/31 37.99 Interest Total Interest Paid 1 37.99 n Curzen[Balanre Daily Balance 111,876.28 Date Balance Date Balance Date Balance 05/31 111,876.28 - MEMO --The variable Annual Percentage Yield(APY)on this statement for your Money Market account is your current APY and is subject to a daily increase or decrease after account opening without notice. Rates are not tied to an index and are subject to change at the bank's discretion. NEWS FROM CITIZENS --This notification is provided to you as a reminder that in accordance with the Unlawful Internet Gambling Enforcement Act of 2006,(the"Act")and other applicable federal and state laws,along with bank policy and the terms of your Deposit Account Agreement with us,you have agreed not to engage in the transaction of business involving Internet gambling, knowingly accepting payments from any person or entity in connection with Internet gambling, or any other restricted transactions(collectively"restricted transactions"). Underthe Act, m,"r FrIc elmltWOiy icniw Citizens Bank Commercial Account Statement 1-800-862-6200 0 OF 2 Call Cadm'Phhuiegank anytime fa a4tbltnt inform t1m, current rates and ansmm to your questions. Beginning May 01,2013 through May 31,2013 Commamal Checking m tnued two,pnviot,5 pag KATHYBASHOR£ NEWS FROM CITIZENS(continued) SPECIAL NEEDS TRUST unlawful Internet gambling generally would cover making a bet or wager that involves use of PAULINE G NE IDIGH TRUSTEE the Internetwithout licensing.We reserve the right to prevent or prohibit the acceptance Business Matey Market Savings or payment of such restricted transactions through any means,including the use of automated clearinghouse transactions,cardsystems,check collection or wire transfers. Intheevent 623183-482-8 we find you to be engaging in any restricted transactions,we reserve the right to take action,as we deem appropriate,including but not limited to,the immediate closure of your account. Under applicable law,regulations and bank policy,we also reserve the right to identify and block,or otherwise prevent or prohibit such restricted transactions and any other transactions that may relate to Internet gambling businesses. Citizens Bank Commercial Account Statement 1-800-862-6200 © OF 1 Call Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning June 01,2013 through June 30,2013 US102 BR289 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUST PAULI NE G NEI DI GH TRUSTEE Previous Balance 111,876.28 Average Daily Balance 111,876.28 Business Money Market Savings Checks .00 - 623183-482-8 Interest Debits .00 - Deposits&Credits .00 + Current Interest Rate .40% _ Interest Paid 36.78 + Annual Percentage Yield Earned .40% Current Balance 111,913.06 = Number of Days Interest Earned 30 Interest Earned 36.78 Interest Paid this rear 290.53 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to qualify this statement period is: $111,876 Previous Balance TRANSACTION DETAILS 111,876.28 Interest' Date Amount Description 06/28 36.78 Interest n Total Interest Paid i 36.78 I—, Current Balance Daily Balance 111,913.06 Data Balance Date Balance Data Balance 06/28 111,913.06 MEMO --The variable Annual Percentage Yield(APY)on this statement for your Money Market account is your current APY and is subject to a daily increase or decrease after account ` opening without notice. Rates are not tied to an index and are subject to change at the bank's discretion. Nm„e rU;C 1=1 'eyaa H,w. 6 ienio; r ; �� � Commercial Account L Z�11S Bank aCi�k Statement 1-800-862-6200 O OF 1 Call Citizens'PhoneBank anytime for account information, current rates and answers to your questions. Beginning July 01,2013 US102 BR289 through July 31,2013 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD - DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE Previous Balance 111,913.06 Average Daily Balance 171,913.06 Business Money Market Savings Checks .00 - 623183-482-8 Debits 00 - Interest Deposits&Credits .00 + Current Interest Rate .40% Interest Paid 38.02 + Annual Percentage Yield Earned .40% Current Balance 111,951.08 = Number of Days Interest Earned 37 Interest Earned 38.02 Interest Paid this Year 318.55 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. - Yourminimumdailybalanceusedtoqualifythisstatementperiodis: $111,913 Previous Balance TRANSACTION DETAILS 111,913.06 Interest Date Amount Description 07/31 38.02 Interest � I11 Total Interest Paid 38.02 GCurren[ealance Daily Balance 111,951.08 Date Balance Data Balance Date Balance 07/31 111,951.08 MEMO --The variable Annual Percentage Yield(APY)on this statement for your Money Market account is your current APY and is subject to a daily increase or decrease after account opening without notice. Rates are not tied to an index and are subject to change at the bank's discretion. Citizens Bank Commercial Account Statement 1-800-862-6200 © or 1 Call Citizens'PhoneBank anytime for account nrormation, current rates and answers to your questions. Beginning August 01,2013 US102 BR289 through August 31,2013 KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY KATHY BASHORE Balance Calculation Balance SPECIAL NEEDS TRUST PAULI NE G NEI DIGH TRUSTEE Previous Balance 111,951.08 Average Daily Balance 111,951.08 Business Money Market Savings Checks .00 - Debiu 00 - Interest 623183-482-8 Deposits&Credits .00 + Current Interest Rate .15% Interest Paid 14.26 + Annual Percentage Yield Earned .15% Current Balance 111,965.34 = Number of Days Interest Earned 31 Interest Earned 14.16 Interest Paid this Year 342.81 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to clual ify this statement period is: $111,951 Previous Balance TRANSACTION DETAILS 111,951.08 Interest Data Amount Description 08/30 14.26 Interest ^ I1' Total lrrterest Paid 14.26 Current Balance Daily Balance 111,965.34 Date Balance Date Balance Date Balance 08/30 111,965.34 MEMO --The variable Annual Percentage Yield(APY)on this statement for your Money Market account is your current APY and is subject to a daily increase or decrease after account opening without notice. Rates are not tied to an index and are subject to change at the bank's discretion. 121 I A,o v,5g-an:^-r Citizens Bank RECEIVED 0 2 P 0.Box7ooD 1-Boo-662-6200 Commercial Acc ffT 2 21013 ROP450 Catt citizenf PhoneBank anytime for Providence,RI 02940 account information,mrrent rates and Statement answers to your questions. O OF 1 _ Beginning September 01,2013 AT 01 121695 1830OB357 A"3DGT - through September 30, 2013 Ilrllrlll'II'I'IIIIrIIrIrIIII1rIIr11111rIIII11111�Irr111111rIIlll KATHY BASHORE SPECIAL NEEDS TRUST PAULINE G NEIDIGH TRUSTEE 738 DELLVILLE RD DUNCANNON PA 17020-9768 Commercial Checking SUMMARY US102 Balance Calculation KATHY BASHORE Balance SPECIAL NEEDS TRUST Previous Balance 111,965.34 Average Daily Balance PAULINE G NEIDIGH TRUSTEE Checks 111,965.34 ' .00 - Business Money Market Savings Debits 00 Interest XXXXXXX482-8 Deposits& Credits .00 + Current Interest Rate Interest Paid - .15% — 13.80 + Annual Percentage Yield Eamed _- Current Balance .15% 111,979-14 = Number of Days Interest Earned 30 Interest Eamed 13.80 _- Interest Paid this Year 356.61 You can waive the monthly maintenance fee of$20.00 by maintaining a minimum daily balance in your account of$5,000. Your minimum daily balance used to qualify this statement period is: $111,965 iRArySAtTI On DETAILS Preyfous Balance Interest 111,965.34 Date Amount Description 09/30 13.80 Interest Total Intrrtst Paid ^ 13.80 Daily Balance f e l Cuvent Balance Date Batarce Date 111,979.14 09/30 111,979.14 Balance Date Balance MEMO --The variable Annual Percentage Yield (APY) on this statement for your Money Market account is your current APY and is subject to a daily increase or decrease after account opening without notice. Rates are not tied to an index and are subject to change at the bank's discretion. -meet FO1C 0 Epulb m,t.®iEg,