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Kathy Bashore Special Needs Trust
Pauline Neidigh, Trustee
INVENTORY
This is the inventory 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,TP Section
P.O. Box 8486
Harrisburg, PA 17105-8586
and coo =; `an
SSI Program Support Team = x r r o rmi :n
Mid-Atlantic Program Service Center r M U ' °
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3'd& Spring Garden Streets :X °
Philadelphia, PA 19101.
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EIN Number 46-6237071 `r'
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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.
II. Personal Pro pe yt
The original trust corpus, deposited into the Trust accounts on December 13,2012, 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 into the trust account was in the
amount of$121,584.88. There is an initial accounting which is being filed with this Inventory
which identifies these funds.
This deposit predates the Trust due to the unique circumstances surrounding the creation
of the trust. The beneficiary,Kathy Bashore, is in need of full time care and is presently residing
in Manor Care in Carlisle,PA. The funds came from the equitable distribution of the marital
estate. Counsel for the trustee was not willing to move forward with the formality of this
Inventory,Accounting or Petition for Adjudication until such time as Social Security and the
Department of Public Welfare accepted and were satisfied with the language of the Trust.
Notice of Account Filing Inventory and Accounting of
the Kathy Bashore Special Needs Trust
Kathy Bashore
940 Walnut Bottom Road
Carlisle, PA 17015
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
3rd & Spring Garden Streets
Philadelphia, PA 19101
Max Byers
Huntindton County Assistance Office
7591 Lake Raystown Shopping Center
Huntingdon, PA 16652-0398
Bashore/SNT/SNT ACCOUNTING/INVENTORY 3
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 Inventory 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
J herein.
_ t
Mark A. Mateya