HomeMy WebLinkAbout97-00199
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R. JAMES REYNOlDS, JR., ESOUIRE
PA Attorney I,D. No. 10252
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REYNOlDS & HAVAS
A Professional Corporation
101 Pine Street
Po.t Office Box 932
Harrisburg, Pennsylvania 17108-0932
(7171 236.3200
Attorney lor Plaintiff
ANN M. HARKESS
ANN M. HARKESS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
vs.
RICHARD J. COYNE AND
ROSEMARY COYNE,
Defendants
NO. 1997 - 00199
JURY TRIAL DEMANDED
COMPLAINT
1. Plaintiff Ann M. Harkess ("Plaintiff") is an adult
individual, residing at 1725 Vassar Avenue, N,W" Canton, Ohio
44703,
2. Defendants Richard J. Coyne and Rosemary Coyne
("Defendants") are adult individuals, who are husband and wife,
residing at 706 Allison Avenue, Mechanicsburg, Cumberland County,
Pennsylvania 17055.
3. On or about April 21, 1982, Jackson National Life
Insurance Company ("Jackson National Life"), pursuant to an
Application made by Mary V, Coyne to Jackson National Life on
April 19, 1982, issued a Group Single Premium Deferred Annuity
Contract, Certificate No. 237163, with a maturity date of
April 21, 2000 ("Jackson National Life Annuity"). A copy of the
Jackson National Life Annuity and the Application, along with a
Disclosure Statement and Table of Guaranteed Values delivered by
Jackson National Life to Mary V. Coyne at the time of issuance of
the Jackson National Life Annuity, are attached hereto, made a
part hereof, and marked as Exhibit "A".
4. The Jackson National Life Annuity identified Mary V.
Coyne as the owner and annuitant.
S, Paragraph 13 of the Application states that the
annuitant retains the right to change the beneficiary under the
Jackson National Life Annuity.
6. The Jackson National Life Annuity provides that upon
receipt of proof of the death of the annuitant before the
maturity date, Jackson National Life would pay to the
"Beneficiary" an amount equal to: (1) the total amount of
premiums paid without interest and reduced by the sum of all
partial withdrawal amounts, or (2) the accumulated value,
whichever is greater.
7. The Jackson National Life Annuity further provided as
follows:
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BENEFICIARY. Any proceeds payable because of
the death of Annuitant will be paid to the
Beneficiary, The Beneficiary, unless changed
by the Owner, shall be as designated in the
application for this Certificate.
(Emphasis added).
8. No beneficiary was designated by Mary V. Coyne in the
Application. However, on August 6, 1988, Mary V. Coyne, signed a
Beneficiary Designation Form provided by Jackson National Life
which designated the beneficiary under the Jackson National Life
Annuity as Ann M. Harkess, a "friend" and Plaintiff herein. The
beneficiary designation was recorded at Jackson National Life on
August 30, 1988. Therefore, as of August 1988, the designated
beneficiary under the Jackson National Life Annuity was
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Plaintiff. A copy of the Beneficiary Designation Form is
attached hereto, made a part hereof, and marked as Exhibit "B".
9, For a period of time prior to May 10, 1990, Mary V.
Coyne resided at a retirement complex in Ft, Myers, Florida.
10. On or about May 10, 1990, Defendant Richard J. Coyne,
Mary V. Coyne's nephew, took Mary V. Coyne against her will from
her home in Florida to his home in Mechanicsburg, Pennsylvania,
while Mary V. Coyne was mentally incompetent.
11. Shortly thereafter, Defendant Richard J, Coyne had his
attorney, Allen V, Smith, Esquire, draft a Power of Attorney
purportedly signed by Mary V. Coyne on May 31, 1990, granting
Defendant Richard J. Coyne certain powers to act on behalf of
Mary V, Coyne (" Power of Attorney"). A copy of the Power of
Attorney is attached hereto, made a part hereof, and marked as
Exhibit "C".
12. The Power of Attorney appoints Defendant Richard J.
Coyne as attorney for Mary V. Coyne to perform certain designated
acts in her name to her lIse. Nowhere in the Power of Attorney is
Defendant Richard J. Coyne given the power to change the
beneficiary designation on annuity contracts owned by Mary V.
Coyne, including the Jackson National Life Annuity, Further, any
power exercised by Defendant Richard J. Coyne was limited to the
transaction of specific business solely for the benefit of Mary
V. Coyne.
13. On June 4, 1990, without the knowledge or consent of
Mary V. Coyne, Defendant Richard J, Coyne appeared at the office
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of Jackson National Life in Rolling Meadows, Illinois, and signed
an Annuity Service Request Form, requesting that the beneficiary
under the Jackson National Life Annuity be changed from Plaintiff
to Defendants Richard J, Coyne and Rosemary Coyne, as primary
beneficiaries, and to Defendants' children, Richard J, Coyne, IV,
and Susan C. Coyne, as contingent beneficiaries. The form also
requested that the mailing address be changed to Defendants'
address, 706 Allison Avenue, Mechanicsburg, Pennsylvania 17055.
The Annuity Service Request Form requesting a change of
beneficiary was signed as follows: "Richard J. Coyne, Power of
Attorney." A copy of the Annuity Service Request Form is
attached hereto, made a part hereof and marked as Exhibit "D",
14, Defendants had oral and written communications with
Plaintiff regarding the personal and financial affairs of Mary V.
Coyne on or around June 4, 1990. However, Defendants, acting
outrageously with an evil motive or reckless indifference to the
rights of Plaintiff, never advised Plaintiff that Defendant
Richard J. Coyne intended to sign and did sign the Annuity
Service Request Form, resulting in the change of beneficiary
under the Jackson National Life Annuity from Plaintiff to
Defendants,
15. The change of beneficiary was recorded by Jackson
National Life on June 12, 1990. The change of beneficiary was
effected by Jackson National Life contrary to the Power of
Attorney, in violation of the change of beneficiary provisions of
the Jackson National Life Annuity, in violation of Jackson
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National Life's internal policy with respect to beneficiary
changes, and without notice to Plaintiff and Mary V. Coyne, the
annuitant/owner.
16. Subsequent to the change of beneficiary, Defendant
Richard J. Coyne improperly relying upon the Power of Attorney
requested from Jackson National Life a partial withdrawal from
the Jackson National Life Annuity in the amount of $75,000,
Payment of that amount, less tax withheld, was made by Jackson
National Life to Defendant Richard J. Coyne on July 11, 1990,
thereby reducing the value of the Jackson National Life Annuity
by $75,000. A copy of the Jackson National Life Benefit Voucher
evidencing the partial withdrawal is attached hereto, made a part
hereof, and marked as Exhibit "E". The partial withdrawal was
paid by Jackson National Life contrary to the Power of Attorney
and in violation of the provisions of the Jackson National Life
Annuity.
17. On November 19, 1990, the Office of Aging of the County
of Cumberland ("Office of Aging") filed a Petition for temporary
appointment of guardianship with respect to Mary V. Coyne. In
the Petition, the Office of Aging alleged that Mary V. Coyne was
removed from Florida to Pennsylvania against her will by
Defendant Richard J. Coyne, that Mary V. Coyne was incompetent
and incapable of managing her affairs, and that it had reason to
believe that the personal funds of Mary V. Coyne were being
dissipated by Defendant Richard J. Coyne through the use of the
Power of Attorney.
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18. On January 4, 1991, this Court at No, 832 Orphans'
Court 1990, entered an Order appointing the Office of Aging as
guardian of the person and Fulton Bank as the guardian of the
Estate of Mary V. Coyne. The Court also ordered that the Power
of Attorney be revoked.
19. On May 8, 1991, the Jackson National Life Annuity had
an accumulated value of $279,569.18, as set forth in the letter
from Jackson National Life dated May 9, 1991, a copy of which is
attached hereto, made a part hereof, and marked as Exhibit "F".
On September 17, 1991, Fulton Bank as guardian of Mary V. Coyne
elected to take a five year interest only option with respect to
the Jackson National Life Annuity which provided for a guaranteed
interest payment for a five year term certain, but which also
provided for the value of the annuity to be commuted if
surrendered before the end of the five year term, A copy of the
Jackson National Life Endorsement dated September 17, 1991
providing for same is attached hereto, made a part hereof and
marked as Exhibit "G".
20. On or about February 14, 1991, prior to the end of the
five year term, Fulton Bank surrendered the Jackson National Life
Annuity, which at that time had a commuted value of $245,980,35,
and exchanged it, along with another Jackson National Life
annuity owned by Mary V. Coyne, for a new annuity policy with
Prudential, policy number 97623316, in the amount of $290,522.19
("Prudential Annuity"). No notice of the surrender or exchange
was given to Plaintiff,
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21, The annuitant under the prudential Annuity was Mary V.
Coyne, and the primary beneficiaries were Defendants Richard J.
Coyne and Rosemary Coyne. Prudential designated Defendants as
primary beneficiaries since they were designated as beneficiaries
on the Jackson National Life Annuity pursuant to the improper
beneficiary change as described in paragraphs 13-15 hereof.
22. Mary V. Coyne died on January 2, 1994, in
Mechanicsburg, Pennsylvania. According to the Certificate of
Death, a copy of which is attached hereto, made a part hereof and
marked as Exhibit "Hit, the immediate cause of her death was
Alzheimer's Type Dementia, the onset of which occurred
approximately five years prior to her death; ~, on or about
January 1989, prior to the time she signed the Power of Attorney.
23. Following Mary V. Coyne's death, Prudential paid the
proceeds of the Prudential Annuity in the total amount of
$313,075.05 to Defendants Richard J. Coyne and Rosemary Coyne,
the primary beneficiaries. At the date of Mary V. Coyne's death,
the Prudential Annuity had a value of $308,692.62,
24. Plaintiff had no knowledge of the change of beneficiary
of the Jackson National Life Annuity from her to Defendants
Richard J. Coyne and Rosemary Coyne, the partial withdrawal from
the Jackson National Life Annuity by Defendant Richard J. Coyne,
the surrender and exchange of the Jackson National Life Annuity
for the Prudential Annuity, or the payment of the proceeds of the
Prudential Annuity to Defendants Richard J. Coyne and Rosemary
Coyne.
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25. Defendant Richard J. Coyne improperly used the Power of
Attorney to change the beneficiary of the Jackson National Life
Annuity to himself and Defendant Rosemary Coyne and to withdraw
$75,000 from the Jackson National Life Annuity without Mary V.
Coyne's knowledge and consent, to the detriment of Plaintiff.
26, The acts of Defendant Richard J. Coyne in using the
Power of Attorney to change the beneficiary of the Jackson
National Life Annuity to himself and Defendant Rosemary Coyne and
to withdraw funds from the Jackson National Life Annuity were
performed by Defendant Richard J. Coyne for the mutual benefit
and use of himself and Defendant Rosemary Coyne, to the detriment
of Plaintiff.
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27. At all times material hereto, Defendant Richard J.
Coyne was acting as the agent of Defendant Rosemary Coyne and
with her knowledge and consent.
COUNT I
PLAINTIPP v. DEPENDANTS
INTENTIONAL INTERPERENCE WITH CONTRACTUAT. RELATIONS
28. The averments of paragraphs 1 - 27 inclusive hereof are
incorporated by reference herein as if set forth in their
entirety.
29. A contractual relationship existed between Jackson
National Life and Plaintiff, the lawful beneficiary of the
Jackson National Life Annuity.
30, Defendants, with the intent to harm Plaintiffs,
interfered with the performance of the contract between Jackson
National Life and Plaintiff by inducing the breach of the
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contract by Jackson National Life in, inter alia, effecting the
improper change of beneficiary of the Jackson National Life
Annuity from Plaintiff to Defendants and paying to Defendants the
improper partial withdrawal from the Jackson National Life
Annuity.
31, Defendants' conduct was not privileged or justified.
32. By reason of the foregoing, Plaintiff has suffered
damages in the amount of the accumulated value of the Jackson
National Life Annuity had it been in effect on January 2, 1994,
the date of Mary V. Coyne's death and had the improper partial
withdrawal not been made.
33. The conduct of Defendants in inducing the breach of
contract by Jackson National Life in, inter alia, effecting the
change of beneficiary, making the partial withdrawal payments,
and ultimately in receiving and accepting the proceeds of the
Prudential Annuity, all without the consent of and notice to Mary
V, Coyne and Plaintiff, to the benefit of Defendants and the
detriment of Plaintiff, was intentional, and Defendants acted
outrageously with an evil motive or reckless indifference to the
rights of Plaintiff. Accordingly, Plaintiff is entitled to an
award of punitive damages.
WHEREFORE, Plaintiff Ann M. Harkess demands that judgment be
entered in her favor and against Defendants Richard J. Coyne and
Rosemary Coyne, jointly and severally, in an amount in excess of
$25,000, the jurisdictional amount requiring referral to
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arbitration by local rule, plus punitive damages, interest, and
costs of suit,
COUNT II
PLAINTIPP v. DEPENDANTS
PRAUD
34. The averments of paragraphs 1 - 33 inclusive hereof are
incorporated herein by reference as if set forth in their
entirety.
35. Defendants misrepresented to Jackson National Life,
inter alia, that Mary V. Coyne had given Defendant Richard J.
Coyne the authority to change the beneficiary of the Jackson
National Life Annuity from Plaintiff to Defendants and to make
partial withdrawals from the Jackson National Life Annuity and
further that said actions were taken with Mary V. Coyne's
knowledge and consent,
36. Said representations were made by Defendants with
knowledge of their falsity with the intent of misleading Jackson
National Life into relying on them,
37. Defendants' conduct as aforesaid was fraudulent.
38. As a proximate result of Defendants' fraudulent
conduct, Plaintiff has suffered damages in the amount of the
accumulated value of the Jackson National Life Annuity had it
been in effect on January 2, 1994, the date of Mary V. Coyne's
death and had the improper partial withdrawal not been made.
39. The conduct of Defendants in inducing the breach of
contract by Jackson National Life in, inter alia, effecting the
change of beneficiary and making the partial withdrawal payments,
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Exhibit A
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JA_lSON NATIONAL LIFE IN... JRANCE COMPANY
Lansing, Michigan
A StocX Company
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Will pay
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THI:; 15 .. "I<('UP C[FTIFICATE. IlEFt::hEIICE tlEF:EIII TO POLICY SHALL. BE CO~STRUE[; . ,
nP~LICA~LE TL THI5 ~ROUP CtHTIFICAT~ U~LE55 SPECIFICALLY OTHE~wISE PROVIOEC.
(l~TIFIC..T~ hU~b[R: 2371b3
CERTIFICATE DATE:
APRIL 21. 19t ,
T~t .~hUITA~T: MA~Y V. COY~E
AGE: 71 FEMI
ThE ow~ER: MARY v COYNE
PL..I:: CRoUP 5IIlGLE PREr.'IU~!
UEFE~RfD AhNUITY
ISSUE DATE:
APR'IL 21. 19,
AIlTICIPATED ~ATURITY UATE:
APRIL. 219 2000
ThI:; ([RTIFI(ATE HAS c,EF.N 15Sl.ED UNUt:,1 THE GROUP peLICY NUMBER 0005001 ISSUEL
T0 THE J~LIC GROUP I~SUR..NCE TRUST.
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UE~EFICIARY: AS INDICATED ON APPLICATION.
RRE~I I Ul,
Schedule SIIlGLE
PREt~IUII payable as follows ON THE ISSUE DATE
Beginning
Monlh
Day Year
TOlal RHENIUM
APRIL
21. 1982
\l149.CJ25.00
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This contract is signed at the home office ot
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EXIlIIH'J' ~<:./. f G i\ A ~"f.'I-
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BASIC BENEFITS
.JACKSON NATIONAL LIFE INSURANCE COMPANY WILL PAY TO the Annuitant, If living on the
Maturity Date, a series of monthly Income annuity installments with 120 months ccnaln of an amount IS .hown on
the face of this Cenificate or such greater amount as determined in accordance with the Annuity Provisions herein.
Upon receipt of due proof of the death of the Annuitant before the Maturity Date, the Company will pay to the
Bcneficiazy, not later than two montlu after receipt of such proof of death, an amOunt equal to (I) the total amOUnt
of premJums paid hereon without interest and reduced by the sum of all Panial Withdrawal Amounts or (2) the Ac.
cumulated Value, whichever Is greater.
GENERAL PROVISIONS
OWNER OF GROUP CERTlnCATE The Owner
of this Group Certificate shall be the Annuitant unless
otherwi.e provided In the application or by certificate
endorsement, Durinl the lifetime of the Annuitant, the
Owner may exercise all rights included In this Certificate
or allowed by the Company, unless the exercise of these
rilhts is restricted by the application, a certificate en.
dorsement or operation of law.
CHANGE OF OWNERSHIP Subject to the rights of
any prior Owner, the Ownership designation may be
changed at any time while the Annuitant is living by fiI.
Ing at the Home Office of the Company written notice
satisfactory to it. When acknowledged In writing by the
Company such change wiIltaJce effect on the date notice
WI\S signed, but without any liability to the Company on
acCOUnt of payment made or action taken by it before
notice was acknowledged by the Company.
mE CONTRACT This Group Certificate is issued in
consideration of the application and the payment of the
initial PremJum. This Certificate and the application for
it, a copy of which is attached to and made a pan of this
Certificate, constitute the entire basis for the Certificate,
AU statements made by or for the Annuitant shall be, in
the absence of fraud, considered representations and
not warranties. No statement shall invalidate the Cer.
tificate or be used in defense of a claim unless cOntained
in the application, a copy of which is attached to this
Certificate at issue.
MODIFICATION OF CONTRACT Only the Presi.
dent, a Vice PreSident, the Secretary, or an Assistant
Secretary of the Company has the POwer on behalf of
the Company to change, modify, or waive the provi.
sions of this Certificate and then only.. in writing, No
agent or person other than the above named officers has
the authority to chanle or modify this Certificate or
waive any of Its provisions.
MISSTATEMENT OF AGE OR SEX If the age or
sex of the Annuitant has been misstated, any benefits
provided under this Certificate shall be such as the
Premiums paid would have provided at the correct age
and sex.
ISSUE DATE Unless otherwise stated 00 the face of
this Certificate, the Issue Date shall be the date used to
determine due dates, certificate anniversaries and cer.
tificate years, which end on the Certificate anniversary
of the Issue Date.
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CHANGE OF ANTICIPATED MA1l1RJ1y DATE
While this Certificate is in force, the Owner may change
the Anticipated Maturity Date from that shown on the
facc of this Certificate by filing a written request at the
Home Office of the Company.
BENDlClARY Any proceeds payable because of the
death of the Annuitant wiU be paid to the Beoeficiazy.
The Beoeficiazy, unless changed by the Owner, shall be
as designated in the application for this Certificate, If
more than one Beneficiary is designated in a classifica.
tion, proceeds shall be paid equally to those
Beneficiaries surviving the Annuitant unless unequal
shares are specified. In the absence of a designated
Beneficiary surviving the Annuitant, the Annuitant's
estate shall be the beneficiary unless otherwise proyided.
NON.PARTlCIPATION This Certificate shall not
Participate in the profits or surplus of the Company.
Form No. GC 101 Rev. 4/82
ACCUMULATED VALUE PROVISIONS
ACCUMULATED VALUE The Accumulated
Value is equal to the Net Amount of Single Premium,
less all Partial Withdrawal Amounts, accumulated at
interest, Interest will be credited from the date a
premium is received by the Company and will cease
to be credited on Partial Withdrawal Amounts on the
date the partial withdrawal is granted by the Company,
NET AMOUNT OF SINGLE PREMIUM The
Net Amount of Single Premium is equal to the total
amount of single premium receiyed by the Company
reduced by the applicable premium tax rate in effect
on the date the premium is received, In the cvent
that a premium tax is impo.ed or the premium tax
rate is changed at any time subsequent to the certi-
ficate date, such that the new rate would be applicable
to the premium received on this Certificate, the Net
Amount of Single Premium will be recalculated to
reflect the change.
CASH SURRENDER VALUE The Cash Sur-
render Value is equal to the Accumulated Value, less
the appropriate Surrender Charge, At any time prior
to the commencement of annuity payments, the Cash
Surrender Value is the tOtal proceeds available under
this Certificate for either the surrender of this Certi-
ficate for cash or to provide an annuity or settlement
option.
PARTIAL WITHDRAWAL AMOUNT The Par-
tial Withdrawal Amount means :.ny amount less than
the Cash Surrender Value, which is withdrawn from
the Accumulated Value.
NET WITHDRAWAL AMOUNT The Net With-
drawal Amount is equal to the Partial Withdrawal
Amount less the applicable Surrender Charge.
PARTIAL WITHDRAWAL At any time prior to
the Maturity Date, the Owner, upon written applica.
tion, may withdraw a Partial Withdrawal Amount,
subject to the provisions herein. If the Partial With-
drawal Amount is not more than 10 percent of the
Accumulated Value at the time of withdrawal and
not more than one withdrawal is made during any
one certificate year, no Surrender Charge will be ap-
plied. The Partial Withdrawal Amount on any partial
withdrawal must be such that the remaining Accumu-
Form No. GC3000 9/81
Iated Value after withdrawal is not less than 15 per-
cent of the Accumulated Value immediately prior to
the partial withdrawal, and in no case may the remain.
ing Accumulated Value be less than $1,000,
FULL WITHDRAWAL At any time prior to the
Maturity Date, the Company shall, upon written ap.
plication by the Owner and surrender of the Certifi.
cate, pay to the Owner the Cash Surrender Value of
the Certificate.
SURRENDER CHARGE The Surrender Charge is
a percentage of the Accumulated Value (In full with.
drawal or of the Partial Withdrawal Amount on partial
withdrawals. The Surrender Charge percentage by
certificate year is shown on this certificate's Table of
Guaranteed Values page.
The Company may defer payment of any with.
drawal amount for a period not exceeding six months.
ANNUAL STATEMENT OF VALUES The
Company shall provide to the certificate owner annu-
ally a statement showing premiums paid, partial or
full withdrawals granted and the then current accu-
mulation and cash surrender values.
INTEREST OF THE OWNER The Interest of the
Owner in the Accumulated Value prior to the Matur.
ity Date shall at all times be nonforfeitable.
INTEREST Interest shall be credited to the
Accumulated Value from the date premiums are re.
ceived by the Company until withdrawals are granted
by the Company, at such rates of interest as the Board
of Directors of the Company may declare, in advance,
but such rate of interest shall ncver be less than 6'h
percent compounded annually during the fllst 10 years
and S'h percent thereafter. Such interest credited which
exceeds that stated shall be excess interest and shall be
added to and become part of the Accumulated Value.
RESERVE BASIS The reserve under this Cer-
tificate prior to commencement of any annuity pay.
ment shall be equal to the Cash Surrender Value then
current, or the greatest of the discounted future Cash
Surrender Values diseounted at 7'h percent, which.
cver is greater: thereafter, the reserve shall equal the
present yalue of future annuity benefits provided.
ANNUITY PROVISIONS
ANNUITY BENEFITS Atthe ,vlaturity Date selected
by the Owner. the Accumulated Value will be applied to
provide an annuity payable for 120 months certain and
life thereafter as detennined from the table herein. or
other more fayorable options as the Company may
make available. In lieu of this benefit, the Owner may
elect to receive an annuity in accordance with the other
options contained herein or made available by the Com-
pany. At the death of an Annuitant before the Maturity
Date. the Beneficiary may elect to receive an annuity by
applying the Death Benefit proceeds under any of the
following Options or other more favorable options as
the Company may make available. Election of an Op-
tion must be made in writing to the Company, The ef-
fectiye date of any election of an Option will be deter-
mined by the election.
LIMITATIONS The amount which may be applied
under any option for a payee shall provide for periodic
payments of at least S2S or the Company may alter the
mode of payment so that at least a S2S minimum
periodic payment is to be made. Any amounts of the
Accumulated Value or proceeds not applied under one
of these Purchase Options will be paid in one lump sum,
PROOF OF AGE Life income options are based on
the Payee's sex and adjusted age on the Maturity Date
or option date. The Company shall require satisfactory
proof of the sex and actual age nearest birthday of the
Payee on the maturity or option purchase date.
ADJUSTED AGE The adjusted age is detennined
from the actual age nearest binhday on the Maturity or
option date and the calendar year of birth.
Calendar Year of Birth Adjusted Age
Before 1900 Actual Age Increased by 2
1900.1919 Actual Age Increased by I
1920-1939 Actual Age
194O-19S9 Actual Age Decreased by I
1960.1979 Actual Age Decreased by 2
1980 & After Actual Age Decreased by 3
EXCESS INTEREST Excess Interest such as the
Company may apportion shall be payable under any op-
tion elected.
EFFECT 01: TAXES ASSESSED AT MATURITY
OR TIME OF ELECTION OF AN OPTION In the
event a premium tax or other :ax is assessed at maturity
or the time an option is elected, the amount of such tax
shall reduce the amount which would otherwbe be ap-
plied :Iereunder,
OPTIONAL METHOD 1 - PROCEEDS AT IN-
TEREST The Company will accept all or any part of the
Cash Surrender Value or the proceeds of this Certificate
not less than S 1,000, and pay interest at not less than 4
Form 1'111 fir.1r}1 "A P"v 4'"''
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percent per annum. The amount so retained shall be
payable through withdrawal by the Payee, unless other-
wise proyided, in sums of .10t less than SIOO. At the
death of the Payee the Company will pay the principal
and accrued interest to his or her executors or ad.
ministrators, unless otherwise proyided by agreement
between the Payee and the Company,
OPTION METHOD 1 . nXED YEARS IN.
ST ALLMENTS The Company will apply all or any part
of the Accumulated Value or the proceeds of this Cer-
tificate to be paid in a fllled number of monthly in.
stallments greater than 120 monthly installments as in.
dicated in the Table of Annuity Options. If the in-
stallments are less than 120 monthly installments the
Cash Surrender Value or proceeds will be applied to this
option. The Company reserves the right to limit each in-
stallment to an amount not less than S2.5.
If the Payee shall die before all installments have been
paid, the value of the remaining installments commuted
at 4 percent per annum compound interest will be paid
to his or her executors or administrators, unless other-
wise provided by agreement between the Payee and the
Company.
If this Option has been elected by the Beneficiary,
such Beneficiary shall have the right to receive the value
of any unpaid installments commuted at 4 percent per
annum compound interest,
OPTIONAL METHOD 3 . UFE INCOME The
Company will apply all or any part of the Accumulated
Value or the proceeds of this Certificate to be paid in
equal monthly installments continuously during the
lifetime of the Payee, according to the Table of Annuity
Options for the sex and adjusted age of the Payee on the
date this Option becomes effective. Payment under this
optional method shall be subject to satisfactory proof of
the age of the Payee. The Company reserves the right to
limit each Installment to an amount not less than S2.5.
If the Payee shall die before receiving all of any fllled
year certain Installments, the value of the remaining un.
paid certain installments commuted at 4 percent per an-
num compound interest will be paid to his or her ex-
ecutors or administrators, unless otherwise provided by
agreement between the Payee and the Company,
OPTIONAL METHOD 4 . CURRENT ANNmTY
OPTION The Company will apply all or any part of the
Accumulated Value or the proceeds to purchase any
single premium immediate annuity contract that pro-
yides a life income or fixed year installments greater
than 120 months which Is issued by the Company on the
Maturity or the date of the election of an Option, The
Cash Surrender Value or proceeds would be used to pur-
chase any other lype of sin~le premium immediate an-
nuity contract.
..
APPLICATION .n. !ljU.J.liJ
TO
JACKSON NA T10NAL LIFE INSURANCE COMPANY / LANSING. MICHIGAN
" FOR'
FLEXIBLE PAYMENT OR"SINGLE PAYMENT ANNUITIES
1. Full nlm. 01 Annultlnt (First, Middl. Ind Lln Nlm.1
'"4.E'mplOYor
I
Se. _Mil.
-z"F.mll.
C,ly - Sial. Z,p Cu<l.
c:.Y/1'8 A'/ t::T ~
Agl' NI'.JIl:U UlIlllll..V Social ScCUfllV Nllmuef ImulI Oe 'lied Int
_ :J '1? - ,p. S7/ /
UU:Ilj1JI"1I1 D.ne Employttd
VI
2. Addrell
.s.J..) t'
3. Dill at aHln
Numbt!r and Street
l/oR/~/1I. ,fpt-.
Month O..y Yl!dl
I), ': t /4/Q
,
5. Ben"'lcllry;
Rl'lilllUll\hlp
CUllllllljl'llt ~1'Ilt'hc..u y.
ReliltlonshlP
1111 untJ~..lOod mill uv.-nc',"ql ,lIl1ll,;lIllllUI olllh' IllHldel Itllll' '\\111'111111111,'11,1\1\ 111 rills, UJlcml.!n, Will he ve,u~d In:
~he Annultanl OOthr.1 (hAll II'" AIII1U1ldlll
(Show name and adrtlcu II othll 11"1..111 till! AlIllllllOUlIl
7. Paymenl NOIIC~ 10; lit ottll'l than Nu "} ..IIJilvCI
Name: __ I NlIl1lhcl Jut! Slll.'L'1 , C"... I SI.JIl'
-L r,;-'- . 1 --- I
8. Please Hlt'cdy tYPl! 01 COlllld71l1t.'llllJ dlJlJhc\1 tUI ,12 Slllqll'll.lVlllClIl COlltlact
. el'1// ," ,- If/!c;L '-/q,.v Allll"".~I_~_._ "./.J !.:,_C ({:..:.
'13 Allllllilalll RehwU Righi
9. Is the annUlIY purchased on a lax qll.lIIII,'eI hJSIS' OVI" ~NII ! 10 1"IoIl1!1l.' 1:31l1ICflChllV cs.Vcs DNa
.__.__ _. _____ j.14 ._~~',c,~~i;J'R;t;r~-mei1i "Ao;:..' ~ 1-'''-'_
10. If conllOJct IS IlUICI1;l)I'cjlO flllltl.11J1l..ldu'lt Illall. ph~.nl~ (15 h IhlS cunlract 10 renl.llcl! any ~xIstln!J
il\(llCall~ .llllllnllllilll~" 1:11111IIIIIIIII'III,d Ifl'\o'~IIIlC ClIIl., : Ith'III'llllaIICI~ IIull(V ur illlllUlly pullcy' DVes
o IRA IS~ctlolt 4081 It )11, !Jlve CUlnlJh:le c.Jcl;.lIl~.
o Sell EmpluyetllSl'c'H'" 4011
o COllllJlJllOIllScCtlUIl 4011
0501 (c1131 O,q'lll1,IIUll IScr:lllJII ~OJ"I
o PulJllc Schuol SYSII~III ISI~l.:llI"l 40311)
o Defeffed COmlltllSiJllUIl IP~~I!~~~.!..!~~~~~~~I___o
11. Payment Jnformatlon tor FI~xdJle Conlrilct onlv:
a. Ill,t,al PaYIn.'" S I .( . (. ( t
I ......
b. AnllCUJdted Annual P,JYOlL'11I 5
c. Moch~ 01 Payment le,rCII! Olll"
A S a PAC
I Zi~ Code
~o
f(j,
SIII'CliJl Requests;
17.
HilmI'! Offlc~ Em!ol)elnlllH (For Comnal1Y use onlVI
I 237163
_---1__.__.. .
5lCfo/s
GENERAL INFORMA liON
NOle that:
1. The acceptance at Ih~ contractlSsu~d on Ihls application shall
constitute a rati'lcalion of ;IIlV Chal1lJt:, COffcCtlOIl 01 addition
made tJy the Company ill1U lIotell III thL' 511iJCe ht:acJcu "Home
Office EmJorsemcl1ts",
2. There has been delivered to the dVl'11t Wllh thiS ilpphcal1011
S , rtf'LI. pavable to Jctckson Nalll.llldl Life Insurance
Company which shall 110t bl' cOn5ldcrcll payment hereundtU
un leu actually honored U~OIl prC)Cntatlon lJy the Company In
the due course of bUSiness.
3. Unon acceptance of a Contract other Ihan as applied for, this
anlllic.1110l1 IlnCludlllU any endorsements In 17 above I shall
lie IOf suc;h motllfttHJ Cuntract, except lhat where required bV
stalult: or Insural1ce Departmem ,egulatlon any change in
plan. i1l110'.Jlll, classification or benefits shall be made only
upon WIII1CII agreement.
4. IT IS HEREBY DECLARED that eacn ollne tUtemenll and
answen C;Ul1ldlned alJove are full, complete and true,
Cash Received ":>')
W,ln ApplicatIon S , ,r.' ~ :~
D"ed an~.//
Slgl1ed at j-<
- Clly
~.f
Slale
onGf,; / r ~
191L-
bY
s..~'7.!.'!'c
('2r ~ ((f~ -)
~'-4r:alv'e 01 Scconu AIJ!;"I II AUIJIIC"UI['
Colle Nvrnlh"
SICp141u,e 01 Owownu II 01"'" '''4n Annull.1nl
UI~\jLv~Ut1t: "11'o1r::IVIr::I~1
St'l'OIont In COI 'foll.ne. Wllh S.ellon 40e 0' ,mil R.v.nu. Cod.
It .ell'l' January 1. 1877
Jacklon "llIon.' LII. Inaur.nc. Camplny
512& E..cuII.. Or'... Llnllng, Mlchlgln ~Ul0
I ACUlEE THAT IF THIS DEFERRED ANNUITY CONTRACT IS BEINO PURCHASED AS AN INDIVIDUAL RETIREMENT ACCOUNT THAT THI
CONTRACT WILL IE EFFECTIVE THIS DATE (ESTAIILISliMENT DATElAND THAT I MAY REVOKE THIS CUNTRACT AND MY MONEY Wll
liE REFUNOED WITHOUT CHAROE ANY TIME WITHI/l EIOHT DAYS OF SUCH ESTABLISHMENT DATE, IF I DO SO IIY WRmEN NOTICE T
THE COMPANY WITHIN THE SAID EIGHT DAY PERIOD. OWNER__~r)J4" Y Vi (} JrJi'1f1L...
For the purpose of qualifying tne Deferred Annully Cont'lct applied fo~ as I Aelllement AnnUity, or an Annuily under a Rellrement Accour:
d8ScnbecJ In SeCllon .coo and relal.d aectlons at Ihe lnlernal Revenue Codl. 1115 'gretd insolar IS the Contract Is concerned lhlt:
1, N01WlIh5tandlng any ath.r provISions 01 the Conuact. 1t'8 Contract Shall be nontransferable and tne ,"Iullnteresl In tne Contrlct of tl'l
Owner II nonlorfellobl..
2. 8enelil payment. 10 the Owner Shill begin no Iller Ihan the close of Ihe lanble year In which he aUalns age 701;' and such payment
m3y bO mlae only (a) In onB lump sum, (b) over a perlc\J no longer Ihan the hfe ollhe Owner or Ihe lives 01 the Owner and Ihe Spouse 01 It':
Owne. r (c) over I period not ulenarng beyond the 1,le expeclancy ollhe Owner. AnnUity diStributions Ire not eligible for Specllllnccm
TUI'\'furaglng. but may qualify lor genorallncome In neraOlng. II these modes 01 dlS!rlbulion are not followed. Ihe proceedS Ire lublect I.
Fet1eral ExclSl tn. whiCh II equal 10 50~/, 0' the amI,unt by which the minImum diStribution each vear exceeds the aclual distribution.
3. Tho Delerred AnnUity conrracl "e.ompllrom FeGo,al glltla... under Soctlon 2517, and Is uempl from Federlllslale I.... undl' SIC
lion 2039(el. if Ihe modi 01 dlstubutlon " etl!ctld unlJer 2. (b) above. 'or 1helomt lives 01 thl Owner and Spouse.
4. If the Owner dies bllor. hiS Inllr. mlerest ha. beln diatllbut.d 10 him. or II distribution hll commenced to hiS surviVing spoulland IUC:
surviVing spouse dies before tho entire m1erest has 01 en distributed to such spouse. the entire mlerest (or lhe remalOlng plrt OllUCh Inleres
It dlstflbutlon Ihereol 1'111 commenced I Will. wllhin liv.J yea" aller his dealh lor the death 01 Ihe surviVing spousel. be dislflbuled. or IPplled I'
Ihe purchaSB of an Immedlato annuity lor hIS beneflclary(IBsl (or tne beneficlaues or hiS survlying spousel which Will be ply_.ble for thelll. 0
Such bano'lclary(les) (or for a lorm cella," not exlendlng beyond thllite expectancy olauch beneflclarylieS) and whiCh AnnUity Will De 1t1"
medlJloly dlslllbuled 10 such benelici.rvllo'l. The pl"cedlng unllnce .hall ha'" no .~phcalion II dlSlIIbutluns o,oralorm coria In commenc
ed bdlore Ihe doatn of "'0 Owner and Inc lorm cert un Is '01 a perIod permitted under Provision No.2 hefBol. Death benefits are subjeCll;
Feaeral ESlal. Ilxes If If'. lolal plOCeed! ale dlstr,ouled over a period of less lhln J6 monlhs.
~. lhn annual stipuluted pa.,.mcnl~ olMr Ihan ..n~ rollovII tonlflbullon from olhl!r quahfied plans permllled by Iha Internil Revenue COdl
lind by reoul~tion Ihereol. Shall n(.ll tucoed S2.000 'Ind any refunds at premiums or Similar distribution Will be held by Ihe Complny and a~
pllea 10wartJ Ihe payment or luture premiums or H. Ih. purchase 01 addlllonallnnully benetll'.
ADDITIONAL INFORMATION
1. The amount permitted as a luable deduction In a taxable year. for Income lax purposes. lor purchase of a Delerred AnnUIty Conlrac
deSCrlbed above. mav nolexceed 100%. ollne Lor ~ensallon Includable In Ihe Owners gross Income In such taxablc year Of S2.0OO 1$2.250 I
Spousal IRA appliesl. whichever 15 le55. Pc.,fIClp"nls In a Simplified Employee Pension Plan are enhlleO to 15'1, 01 compensallon up I'
S 15.000. AllY dXcesS contributions are sUblect 10 r:edctal EXCise tlx unOer Section 4973.
2. No deduction is permlttcd lor olny lal(3ble ye..r duuno which Ige 70V. WIS IUained b\' the Ownel.
3, If dunno any taxable year la) any 3mount IS .lorrowea under Of by use or Pledge of Iho Conlrlct or (blthe benefitted Individull or hi:
I.Jl.Inulll.:lJ.ry cngiJgos In ilny ptohlLJllfJlJ 1I.J1l:i.1clll 1I dUSCrlblHJ In Section 4975 (cl. With respect 10 the Contract. II shall then cease being 6-
OU<shllea RotJrement Annully and the 11111 value,.1 the ConlraCI shall he Included In Ihe Owner's gross income tor thai taxable veil.
4. II an',' ...mounlls Withdrawn 01 dl:illllJulcd' 10 [he Owner tram Ihe CC1nlraCI pliO' 10 his allainmenl 01 age 59'/' for any reason Olner ,1'1.,.
dlsal1ltlly. then an adlJIlIonallax. eCluilllo 10~'~ .llhe amour.l Withdrawn may be Imposed on the amount so Withdrawn. .-
5. Tne Owner 01 a Deterred AnnUity ConlraL:1 n Islllle lorm 5J29 (attaChed to the Federal Income Tax Return) '" rt:pOrllng an eXClsalax fo'
OIn llltCC!lS contflbUllnn. promaturo c:JIslflhullon nr1 ,"sulflclenl distrlbullon as determined bV IRS Regulallons.
6_ P,llceco:: from thiS Contracl may he usea .. . d rollover conlllbullon In accordance wilh Ihc prOYISIonS 01 Section .08 (dl (31 ollhe IRC
SUPPLEMENTAL INFORMATION
Thure .lire no ..nnual c"arQes or allrnlOl'>UoJll'Ie I, :5 cnargeo to Ihe Annuilant other Ihan a 1'/, Surrender Charge which is Imposed only II Ine
Cunuact IS surrenderad III Ihe IIrsl yeoJr Aller' Ie lirsl year there Is no Surrender Charge, P,emlum laxes. It applicable. shall be deducleCl
fronl EITHER the gross premiums paid OR the J.. .oceeds which are applied unde, an annuity opllon. depending on Ihelaws oltne applicable
s1ale
','i1.10"; 'Irmlnla;;;;;i.
Gro~p AIl"....y
15.nlo, M&I rlan
AI .111I'111;,.';11."" I. A;;.c
. 4".Jlt'er""ur."
..h........~ IIIIr1wl_r
E.lpllnl'
I
I
"
I
I
:
FINANCIAL DISCLOSURE
Tholcurr~nl_i!!l'I Gu.ranlced Values shawn be ,w~'el1:>Am.. S 1.000 of Single premium. The Current Values are based on an Inlerest rate
at __ Y.J~- 'I, Whlcn IS I"e curronl lOll!'! I InlY _7J,..(.These ligures are not guaranteed but Will depena on the ,"Iorest aClually
iZolln ",."
clt!dlled each year. Tho Guardnl~ctJ ACc.um..lallon Value IS based on 6'1,'1, compound Inlerest during the first ten years and 5'1II.'C
lherealler.
End 01 POlicy Yur
Currenl Accumulation V.lues Guar.ol..d Accumulation Valuts
(bInd on 11.000 01 'ingl. prtmlum)
____JI.l~- $1,06500
'.1./.7 - 1.1303
If/I.' 1,20795
f2'ff 1,2B6~7
._.____,'9.!Z(L- 1,37009
-9- -0 -
-0 - -0-
Age 70 -0- -0-
JACKSON NATIONAL LIFE IS REOUEST"O AND DIRECTED TO MAKE THIS DISCLOSURE STATEMENT PART OF THE CONTRACT AND
WHERE THE PROVISIONS OF THIS DISCLOSURE STATEMENT ARE INCONSISTENT WITH THE PROVISIONS OF THE CONTRACT, THE
PROVISIONS OF THIS DISCLOSURE ST!. TEMENT SHALL APPL Y.
I, THE UNDERSIGNED OWNER, HAVE RcAO AND FULLY UNDERSTAND THE ABOVE INFORMATION.
1
2
3
~
5
Age 60
Age 65
~Ig .nthls ___1 "*, dayol aft~,19 f:<, at -5-1 ~o O-~~
-1t;;;~;J~, .,,/ .UbI 7-Z9tJ- X-~_1!l/;.0~
~IOr\ . U(Jc/~l',tt--- . Code No. ~-O--(fSignIIU'e of Ownl' 1
WHITE CC 'Y TO COMPANY. YELLOW COPY MUST BE LEFT WITH OWNER
FlHm Uo srOA ISenlon Rev 1,'82
JACKSON nATIONAL LIFE INSURA!,CE COMPANY
'.
. 51) 21) 1:..eCul 1\ r I', 1\ l'
. ,
~
I.Jn>III~, ~II""~,III -Iii') I 0 ". .
. ,
TAbLE CF GUAR~~TEEC VALUES
J'LAt,: (:riUUP !:.II'GL.[ I'REMIUM CEFEH~E!J Af./,UITY
i'LT A/-CUilT OF SINGLE PRE~.llJ~:
5149,925.00
CERTIFICATE NO: 237163
AGE I 71 FE~IAL
T"l VALUC5 SI'CI\N II. TnE TAhLE ^'<~ UASELl uN TbE NET Ml0UNT OF SINGLE PFlEMIU",
~"'L,\,I. I<1ll!V( ~,llll TIlE uUAt~A/JTEEt; All,jU,IL "lTEIIEST RATE OF 6.5016 FOR TEN YEAIiS
/."L ,.,0'.. Tt'ft;EAFT[/:. TtlE AcTUAL VALUE WILL Uf INCHf.ASEC; BY ANY AMyUNTS of
rXtlSS II,Tl~15T D~CLAR~O tiY T~E BOARu UF CIl!fCTORS AUD WILL BE REDUCED bY
..f,y PAFT I t.L \, I TIi(IHAIIALS.
III LF l'uLIC\' yEJ,H
ACtUMULATIUN VALUl
1
2
3
4
~
6
7
8
9
10
11
12
13
14
15
III
17
Ie
5159,670.13
170,048.69
1lil dOl.li5
192,873.47
205,410.25
218,7bl.92
232,981.44
248,125.23
264,253.37
2111,429.84
296,9011.411
313,23d.4~
330,466.56
34A,642.22
367,817.54
38A,041.50
4CJ9,390.11
431,900.57
CASH SURRE~OER VALUE
ACCUMULATION VALUE
LESS SURRENDER ChARGE
IF APPROPRIATE.
515111073.43
170,048,69
181,101.115
192,873.47
205,410.25
218,761.92
232'981.44
248,125.23
264,253.37
281,429.84
296,908.48
313,238.45
330,466.5b
346,642.22
367,817.54
388'047.~O
409,390.11
431,906.57
f.ASED 011 I'; lid Nl../.'
GU_~AIlTEEu ~ATE.
Mil b9
)431,906.57
5431,906.57
(,UA~:AUHI:.[; e1ut,THLy llieO"!: AT AGE 89 = ~4,262.91
lloOtHHlY ANf,UlTY-I0 YEARS CERTAIN)
ThE SURf..ENUER CHM'GE PERCEIITAliE tlY PCLICY YEAR IS AS FOLLOwS
FIR5T p0LICY Y~AR ... Ii
~LL PULICY YEARS THEREAFTEK ... O~
GO 005
... \ . . . . . ..
exhIbit B
, .
" . .
o JACIQ N NATIONAL LIFE INSlJRJ..._ .CE COMPANY
o JACKSON NATIONAL LIFE INSURANCE COMPANY OF TEXAS
S901 Executive Drive, P. O. Box 24068
Lansing, Michigan 48909
(Sf7) 394.3400
C!
BENEFICIARY DESIGNATION FORM-
POLICY NUMBER
237163
PRlMAK\', (Poyre II delm of ""Urall
INSURED
IAARY V. COYNE
OWNER (If olher than Imured)
N/A
NI/TIt Ann V. Harkass
PIlJMAllV, (Payee II deem of ""ural'
nos, 1-23-22 NI/TIt
nos,
S,SI
29~7-4l3h
S,SI
Rl:II"OftlJllp Frisnd
Add",.. 1725' Vassar Avanue N.W.
Canton, Ohio ll703
Rl:lallolllhip
Add",..
CONTINGENT, (Poycc ,I no Primary Paycc IIVIRII
CONTINGENT: fPayee ,I no Primary Poycc "....I
NI/TIt
None
nOB.
NIITlt
noa,
S.SI
S.SI
Rtlluonuup
Rl:lllIollllllp
Addreu
Addreu
,
A. Unl... 01""",'1< din:ct<d, 1hc: pn>eecda &haJI be paid in eqllllllwa 10 any
prima'} bencracWle1 who wnive &he Wu.ta1: bu. If none IUrvive, the pr0-
ceeds &hili be pud in cquaJ Iharu 10 any conuna:cnl benelicWics who IUnive
1hc: 'naurod. II no des.pwod benc{",Wy IUIV,,,,, 1hc: 1IIIWtd, 1hc: proccod& &hall
be paid to lht Insured'. UUIC (or u cxhcrwLJe provided in the polLey).
D. The Company shill not be ruporuible (or the use of any sum p,ud co. Trustee.
Pa)mcnllo I Trustee: wll dlKhl'IC any 11IbllllY of !.he Company lO the Utenl
of lhe pl)'lTICnl nude. If Ilnnl dou not UI&I or IS noc \'1hd. or If the qu.ahl)lna:
coOOlllonl lor I Irusl under I Will h.noe noc been mer II the lime p.l)'menl IS
made. paymenllhaJl be made to the IUCXCCduII dcSIIRlltd beneficl1ry, Ir In)',
othe.....11e 10 the insured', awe.
GENERAL PROVISIONS
I "''''by mcil all pnoI beneflCWY des'IN\IOftI and mUz!lle beneflCWY desI,I\I'
liOns Indlc~ted abcM IIUbjetllo Genenl Provly~n..!) 11 to each Policy numbered
Skokie, Illinois 00077 ,
D'lCd" sw.1.- ~ ~
-0\". : .. l. 0(l.~
'''"m , &ffd--
Zf'-aL ~,
w"n"~ ~
Wllnen
C. If child..n of I penon an:
chiJdn:n IepJly ace-led.... by,
&hall be iDcJudcd u benef",iariea.
of 1hc: elw of .hildn:n, IllIIcu apoci/i
D. Your chanp: of beocflCWy may be n:axded w,lIlOU Il1III OOIll<lU d)OUr
'pow<. H~r. you II10uJd be aware of 1hc: faa 1Ilal, iJ)OOr 'lIIC Ilu com.
munuy propeny I....., .uch 'pow< may """ nsJIIa IIlal may be JUC<CUluIl~
aliened lpltul p.ymenu by the: CotJ1tUY ri bcndill under the polity.
E. UnJ... othe....ise pn7o'rdcd by lhe pohcy,lhia dw:p: ofbencfiei.lty IhalJ be dU<.
lil'l: only upon """'pI of 1hc: chan,c .. acccpllbl. lorm 111hc: Ho/Tlt om.. 0(
1hc: Company,
above. With rupeel to tluJ bcneflCWY dulanwon onJ)'. Lbe Company waJve.I IU
",hi 10 hftC Ihe Policy lurrendered 10 the Home Of(KC.
cUy of n f ~Jll.
'~'n.1/J- f61,~ SMr")
SiafU1ure of I d
N/A
thll
~
, 19
~
SigtUlure of O...ncr fir other thin huurcdl
IliA
Slgn.iIUre 01 Spouloe lRequlred In III communu)' propen)' Stlttll
N/A
Recorded ..I J"l.7unn N~llonll Llk \..
i( d-/, 1t., tt-
SI~nllure 01 IrreVtKlble Bcneflcllry
D.IC f ,$"f'yI
-For SpeC I,d SClIlement RCliUhh u\C FIHm No IH.l
EXIlIl3IT
kw... No ll~2 =111
"n"
exhibit C
n'
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AU.!H D. 8MlTJ1
A1TOlHEY AT LAW
--
-
rOWER or ATTOR~EY
~ov AlL KEN IY THESE PRESENTS, that t, MARY V. COYN~, do mak., con.tltuta
and ~ppolnt .r ~.phIW, RICHARD J. COYSE. ~y tru. .nd l.wful attorney Cor
.. and in .)' na.. to II)' u..,
I. To .ak, colllCC, d...nd. .u. tor and rlcllve all IU.. at .0r.IY,
lnclrlat, dlvidlnd., dapoalt., Ihar.., ..curltla., accounta, pin. Ion.,
&DAu1tS... rlnCI. chi proc..d. of 1n.urlne. ot Ivary kind. racir..ant
baD.fit., bODd., and bulldlne Ind lo.n or Ilvine. and lOin .har.., Soclll
S.curit)' Ind Kldiclr., now dUI or whlch moy h.r.aftar b.co.a duo Ind
pl)'~bl. Co ~ 10 Iny ..nnar whaclolver. .nd upon rlcalpt at .arol co alln,
aul, ..acuta and daUver .11 IIlcea...y acquittlnc.. and dhcharCII
cbar.ior;
Z. To ..11, ul1en lI.d cranohr .ny 1C0rka, bond., cldlllll, .hlrt..,
Iccouata, dlpodu or other ..."rH1II nov Itandlna or thlt ...y hlrutter
atlod 1n ay oaK. on the bOOLe at eny and III orpuratlonl, nlrlonal,
IClt., aunl,.tpal or private:
3. To Inv..t .nd rllnvelt In .ut~ ,"'uricl.. ~. my Ilid .ttorn.y
dll. lat. and Judlclou. to hold tor .y Iccount:
4. To .ndor.. notu. chlckl. dratt. or other nlsotlablo 111.tru.lnra
..,
payabl. to .y order ~hlth ..y rlqulre e~dor..ment Cor dlpoal: al c,"h or
.'
for collactloo, and t, ....ke or .nter Into Iny a~r....ent or acr....nt. ~r
th. ..na,.mant of .y ,Cfalr. .nd proplrty: ::
S. To drlv chick. oClln.t or oth.rvl.. .C!.cc wlthdrlwal. froD ~
checklni or .lvlnRI lunda or ~cher account. Ic.ndlne In my nl... In In~
bonk. .Ivlna' in~tlCutlon or building and Iron u..oclltlon; :3
n.
-
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6, fa p.y, dtscharge .nd leccll ~ll account., J.bc. and d.....nd. ,_,
vhlch are nnw or ~hl,h may here~Ctcr b.coxe du. .nJ r.yoble by mal to ~y
.ll my blll., Includln~ th~.. Cor ~y r..1 ..tutu, ham., 11~ln&.
bou..k.apln&, nodlc.I, ~o.~lt.I, nur.loa. roo. nnd board, car., .nd III
charlie 1n .: : nUflin, "f cony.le~cont home. ,nd t.x... which ~y nay or
h.r..Cr.r b. du., oWlnK or payable by CI;
7. To r.pr...nt .a and In my beh.lt to votl and .ct, In Plr.on or b)'
prolty. for.. at III lI..clng. connected wS th any comp.ny In whlch I lilY
ovu .tocLo or bondl or b. Int.rl.c.d In any vay what.olvar:
. .
8. T~ .ntlr 4nd take ro"...1o~ ~( ~~ .~'r de~o.1t bo~. and the
eontlnc. th.r.oC, and to Cl1. ~!1 lnc~m. tax and ochar tAX rlcurn. And
cl.ll1o Cor r.Cund. on ~y b.h~lC;
9. To take charl' DC ~11 MV ~rop~rt~ of .v~ry n.turp .Ind to ~'Y .11
billa 111 con~.'ctlon ~ich thl '~m~;
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EXIfInIT
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Id.inllcrlCinn ot .nullchlclc
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h,lt II n
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co~""nc tll ,1:1 ur"r.H Ion .1:'1d 'hv
or Dlco~ trunaCu..tlln;
II. ':'0 uintafn A:!d u'u, .2:~ n.Cttfioll.1rY rlrnlrK or. .,11 f,nl v,Cilh:
o",,"d br .., Includln. S::O n~kco~ scruc. nn~h, Conk Cou::cy, lltlr.lllr.
.nd CO P'Y .11 bUlK In connlcclon with ch. mAlnten~ncI o( ..,Id ~ru,'.rCi';
co lec, d.al.. .nd ronc cnr roll ..cu. O\i1l.~ hy "", or In ..htclo I h\V.
Iny Jnc~r..c. tn~l~dlnK ~~1~ prop.rt~1 nc ~u,h rftncn ~nd on Mllell t'r~. ~M
.y laid .ceorn.)' . !.,11 duo prop.. 01d n.pedt.nc; ,0 racllv., ,1.","",
col1.et and r.C'ov.r .11 r.nel o1nc! .,rr,.1r.. nt time II \t'htC'h IIAY II ll': d.' I t.r h&t
~u. co .11 '0 ,oill .11 t,wCul ....;..., .nd ~u."" :or thc r.covo'!' ''''INnl
1ncludinJ: .n:.rtn. uVon .Iid pr.r:~.'.p". dit;th.,....Jh. .mitli Qnf~ cunr''u'i:ll'r...,
ood o.her proc. dlna. oc t...;
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hav. Iny tntlrrlc. lncludS"C 5~~O Gui.tcn ~tr'lt. Sltok1.. Conk COU:1t~.
1111001.. .t .Ich.r public or rr1~... 1.1., "' .uch cleu .n~ Cor .uch
pr1c. and upon luch clr.. and condic10n. ~I my ..Id .t,orr.o. .h.ll think
proper. .nd Cor.. .nd In ay n.... '0 araM .n.) conv.) ..Id rloll ..c... .n
ChI p~.ch'".r or purch...r. thlrloC "0 th., ~.ad .no! allCr1cllnt Clcl. co
cho "'" b. alven co ..Id purch...r or purcho,"r., .nd (~r lh~c pur~oel ,n
aok.. IX'CU'.. 'CkRowlldK' ond d.l..or land and lu(C1c1In. cancr.cCI.
dl.d. in f.. at.pl.. and (':1v,y~~c" for thw '~:a. wich 41:h.r covellont.
at aln.ra' (1r eplctal WOlrrnn'."III. ...hlcla may h.. flqulhlro or pr"plr to
.tt'ct~c. tho 101.'; to .",ak. J,.tr.":1d. r.cUVC( .and r,c..h', all MUg. of
IIOnl), wh1ch aholl bocn"~ due .'nd nwt~K tt' ~. ~'l ....n. oC .uth b.r~.I~ or
a.l_. Ind to l..ll. 111 lavC,,1 ""~'I' alld I:uean, fllr the ret'oVl'ry tharunf. And
' . ~
to ...eut. ,lnd c!.llvl'r "u(!1~tc:1I: ~lu'h..r",w .,r\! ,1c(l'dtt,1ncuc theralor.:::
and UpUft the 1011. 0: .~1c! .,roJlI-:rty to rl~ ,1J I :,IXC1l, wlttar .1r~ liVW', ro=M.
and ath.r ll~~. ~nd III ..pena.~ ~f th. M~l~,
w
&~ytn& "nd s:rlntl!':K untCt .Y .alcJ cttnl:1I)', Klehard J. r;oYllc. lull pawa~'
and auch,rUy :0 do and prr:"rm .Ill And every o1cL anll t!'11nh WhAC.o.var-
r.qui.l te .Jnd n..cehSLt\' Co bt d!J~. I:: ,100 .1~OIJC ralu ,rlml.eft. .JJ full:'~o i;
.11 lnc.nt. ,1nd ;Jurpr,."". .1M r f\l&hr or rUIII.1 do 1f jlorlnr.ally prl.lI'~C'VI I"
wLCh full I''''"".r 0: HuL..cllutl..n .'nll revoLAtiun, h,.r~b)' rAtifytng .1n"': c...
cnnCt'~lnR .11 .h~. ~, .~.d .ttn,".., ~Ich.rd J, Coyn., aholl I~..'ully do
or CIU.. to b. tlnn. by 'ltrtu. IUlft Jt. It I~ uxprc.'hldv und.rACOtld elHlc no
'cc1ol~ hy K" ~n du'nv I'. r.r"on .-.'; n( thL ,"'t" ~,"ruII11urll"rt:,.'d to 1..0
don. ",b..qulncl~' en ,~.~ Cot~!;I~ o( tht. l~Hrur.unt "h"l1 bl tr<lI,ed II .
rcv\Jc.c.':on 01 ch. '.01
Thi. po".r of IC''',n..':1 .h.111 cnntlnur In (I :"'('t! dlld Co:AY bu 11ecapted
and r.ll.d upon by .n)'~n. tu W~IO~ It J~ prc_vllc~d deh~'er my pur~nrtcd
revocation a! It or U~ ~.."ch. ur.t'l .1ctuOJI wrStten ~.1clcC' o( .fthvr oC
lueh ,'Vlnt. 1. rrcll~.a b)' flU'~, ;..rfll':1. In th. .ve,.e or II~ lncOrtl'cteney,
trOft wh~t,v'r CAU... thf~ vou~r O( ~ctorr'y ahall not thurrb~ h~ revukad
bur Ih,.ll th.r....po" b,:,,~. lrr'\'I"Clblt a~d ~o1y bl~ .1CC'l!rt.ul .tnd r.lt.d UtiI'"
by .nyn~. tu wntla I. 11 prl..nc~d dr~pltt !'llen lncn~p~c~nC'v. 'u~J~et only
to 1t b.coa1nc \'nl~ JnJ lie no Curt her .(!r~l, o,ll~ 11~"n r.cwl~t by ouch
r.r.~" .tt~rr o( ~I) uritt." '~1~.n(e ~( ehn A?:.'tnt=I'"~ uf 01 ~ulldl~n (or
.tol1.. !lduCI~:yl 01 ~:: ,'U,1tu (~llo\lj~~ .'I'uo!lc,lltlln n: Inrnor.clnc:, or
,1) ~rJct'n nOl~C~ ~: ~y J.~rh.
Exhibit 0
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Exhibit E
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!
I JACIqON NATIONAL LIFE INSURANCl!: COMPANY
5901 EXECUTIVE DRIVE · LANSING, MICHIGAN 48911
.'
"
ANNUITY AND INDIVIDUAL DEPOSIT ADMINISTRATION COST
BENEFIT VOUCHER
I
f
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~
3L
~
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C'::We, ,~A;{'t ~
~/C ~;CHA~O J. C~y~~
700 ALIS'::~ .vE~UE
l=CH~HICsaUaG, ~~
AREA S .3
AGENU 0007791.1
SHAOEL,OCR':THY
.!.7C55
-1
IMPORTANT: RETAIN THIS FCRM FOR YOUR TAX RECORDS.
We will send the proper-lRS tax form following the end of this tax year,
NAME OF INSURED: C:~'l!k, "0Ii( 't 'i
POUCY NUMBER
ISSUE DATE
OUALIAED
NON-QUALIFIED
PLAN
ISSUE
AGE
COU":_ 11.30
O'o-;:.l-'i.l
.~CT "UALI:=
.. OlO:
7.
DATE
\l'1-~.l- ,0
AMOUNT
07f~UU.uJ
r.,;r oil. '>~.=:"l.,,;l~ oI:iC/CR :t;~':$.-r:; oAI::
:...~,.~:::3.uO
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oIC;:U.~UI.~TI':;i 1~:'I,;E .I~ Cf: O,-ll-"O
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~,"'~l,.i~ j Co? ':;~,~.~~:'f':::~ (~lC ~U~R=...:;:~ "::1Artuc)
~.....':\"..j .:? ~iJ:J~:"'c:;P. (Su.JJ,:c; ;: ::n$!P,j2)
3;6, :'J4. j..,
75."00..',, '
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;:, .::oc. ,~J
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J. i)::
..1..'!.iT.INIHNG ?GLrey. L;).lN ~ cr:. u7-11-'N
EUl A;~GUNT S:"R.~='lucil.:::J ,,~c~ ~CCU,'1lJLATrG;15
.jALo\,iCE JF A(C",MUL~ TluNS MTE~ SJil:~cIW.:~
0.00
'1'5, CCC. J:
21>.l.:5..4.76
D~:~CT T~X ~li~HEL:
7, 5~~C. ~':
NeT PRaCEEO:
,,7,300..)')
EXHIBIT
E
l:vhlhl. l:
I
Annuity Policy #0002371630
4/2l/82
Deposit
$l49,925.00
3/20/84 Withdrawal $3,000.00
l2/ 6/84 II 10,000.00
9/l9/85 II 1,000.00
l/28/87 II 2,000.00
l/ 5/88 II 5,000.00
4/20/89 II 5,000.00
7/11/90 II ($7,500 Tax
Withheld) 75,000.00
Total Withdrawals $lOl,OOO.OO
4/20/89
4/2l/90
7/l0/90
7/11/90
5/ 8/9l
Accumulated Value (after withdrawal)
$302,5l4.76
$330,277.86
$336,594.76
$26l,594.76
$279,569.18
II II
" ..
II
II
(after withdrawal)
" 11
5 yr. Int. Only Option - $l,907.07/mo.
".- ..
I
\
Mary V. Coyne
Jackson National Life Insurance Co.
Annuity Policy H0002040710
6/28178 Net Deposit $48,000.00
2/ 9179 II II 19,200.00
4/25/79 II II 38,400.00
5/13/80 II II 33,600.00
11/11/80 II II 9,600.00
Total Net Deposits $l48.800.00
4/l2/82 Withdrawal (To Open Annuity HOO0237l630) $ 50,000.00
7/ 5/83 II 5,000.00
7/24/86 II 2,000.00
9/15/86 II 2,000.00
8/29/88 II 5,000.00
11/l6/90 II ($3,000 Tax Withheld) 30,000.00
Total Withdrawals $ 94,000.00
4/l2/82
11/ l5/90
11/16/90
5/ 8/91
Accumulated Value
11 II
$l93,538.58
$ 85,807.64
$ 55,807.64 (After Withdrawal)
$ 58,137.09
n "
II "
5 yr. Int. Only Option - $396.58/mo.
......- ~.
I
8/ 3/81
9/ l/82
7/ 5/90
9/ l/82
2/ 3/90
7/ 5/90
7/ 6/90
8/ 6/80
12/l4/8l
9/ l/82
7/ 5/90
l2/l4/8l
9/ 1/82
8/ 6/89
7/ 5/90
7/ 6/90
Annuity Policy *0002230350
i
f
Deposit
$lO,OOO.OO
"
,
Withdrawal
II (To Close A/C)
$ l,073.17
25,688.99
$26,762.l6
Total Withdrawals
ACCUlll.llated Value (after withdrawal)
It It
$lO,719.88
$24,733.00
$25,688.99
II
(at closing)
II
-0-
Annuity Policy *0002l66220
Deposit
$lO,OOO.OO
Withdrawal
$ l,l40.32
6,400.00
12,768.86
II
II (To Close AlC)
Total Withdrawals
$20,309.l8
Accumulated Value (after withdrawal)
It II
$lO,262.88
5,857.79
11,750.26
l2,768.86
-0-
It tt
II
II
(at closing)
"., .
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JACKSON NATIONAL LIFE INSURANCE COMPANY
5901 Executive Drive, P. O. Box 24068
Lansing, Michigan 48909
(517) 394-3400
~
i
Annuity Benefit Options
Th be sent to Jackson National Life Insurance Company
Policy No.
0002371630
Name of AnnuiUlnl MaN V. Covne
(Please pnnl rwnc I
ELECI'JON OF INCOME OPTION (Deferred Annuity Only)
o Income Option A - life Only IXI Income Option E - S.Year Imerest Only
::J Income Option B . life, Year CeMain 0 Income Oplion F. Joinl & _ Survivor, _ Year CeMain
:J Income Oplion C . life, InslaJlmenl Refund (full, ~ or 'h)
:J Income Oplion 0 - Year Term Cenain 0 Income Option G. Benefit Cenain
o Other Income Oplion
I hereby elect !he income option indicaled above with benelil 10 conunence ASAP
(Date)
If a dale is nOl specified, benefits will begin 30 days from the dale !he form i. received al the Home Office.
Frequency of benefit payments IXI Monthly C Quanerly 0 Semiannual 0 Annual
?LEASE SEND ?ROOF OF AGE FOR A.Ni'lulTANT.
c:p~ ,_'(bin, ,;'::1:::':Jt.: 0r ~r:\".:r~', ;IC~~~~.1 :F ::JI~jT :)?'"~O~;5 C:-ICSC~~. ?ROOF OF .\GE 15 REQUIRED fOR 30TH.
WITIffiOLDING ELECTION FORM FOR PERIODIC PAYMENTS
Complete the following applicable lines:
1. I elect not to have income laX wilhheld from my pension or annuiry. (Do not complete lines 2 or 3.).........
2. I want my wilhholding from each periodic pen.ion or annuiry paymeDlto be figured using the number of allowances
and marilaJ !talUs shown. (You may also designate an amOUDl on line 3.)................................
~arital !laIUS: Xl Single 0 Married 0 Married, but withhold at higher Single rate
3, I wanl!he following addilional amount wilhheld from each pension or annuilY payment. Note: For periodic paymenlS.
you cannor enter an amounr here wirhour eorering the number (jncluding zerol of allowances on line 2. . . . . . . .
o
1
IEnur number
oI&1I~~1
s
STATE WITHHOLDING ELECTrON
I ......nl S
o
or
% of State Income Tax wilhheld from my periodic payments.
?!..:::.\SE ;mTAli- ".OC:l .\.."iU!7": .''';!..:C..
'..': ~\~',r 1:;:::.IE:Y;' ',VILL JE .?OR'r'VARDED ':rJ '.D(] ':-0 ~E :'L.+,l'~:J ~JI'~:'i ~'Ct.] "~~l.~C.:.
?L:~.'h~i:: ~ .~: .'.f!'!....::.:.::: :;t ;TH :~.\(;::~; .
-- '
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':.:':- ....:1 \:';, ~~Tt"a~; ':(}.;.'.i..::\Sii~.. " lTiC';,....i. ..::~~ .:';:~L~:.....~~::. . ,'.JP:\.'::.
~r.:':. ~L\ . ;:;E~)
t) .. .~::{ '.CI ~ ':..:;..:.::U;'"
p(i
DEFERRED ANNUITY BENEFIT OPTIONS. TIlE CHOICE IS YOURS
CJ The infonnation provided below is based on a firs! benetit date as of
for 15 days from
and i. guaranteed
~ The infonnation provided below i. based on a projected fir.t benefit date of
and is nOI guaranteed.
Accumulated value
Cash .urrender value
INCOME OPTION A: (Life only) Equal payments will be made 10 the annuitant as long as slhe is living. Benefits cease at the
death of the annuillllll,
There i. no righl to select lump-sum payments for the annuitanl and!or owner.
Amount
Frequency
INCOME OPTION B: (Life, Tenn Certain) A lenn of S through 2S yean is available. Equal payments will be made 10 the annui-
tam as long as slhe is living. DEATH BENEm: If the annuilant were to die prior 10 receiving the tenn certain payments. any
.uch unpaid payments shaU be continued 10 the designated beneficiary.
There is no right to select lump-sum payments for the annuitant andlor owner.
Life,
Yean Tenn Certain
Amount
Frequency
INCOME OPTION C: (Life with InSlallment Refund) Equal payments will be made to the annUilanl as long a. slhe is living.
DEATH BENEm: If the annuitant were 10 die prior to receiving payments equal to the value used at annuitizalion, the remainder
will be paid in insla!lments to the designated beneficiary.
Amount
Frequency
INCOME OPTION D: (Tenn Certain) A tenn of S through 2S years is available. Equal payments will be made to the annuitant
for the .pecified period of years. DEATH BEN Em: If the annuitant were to die prior to having received all payments due under
this policy, payments .haU be conlinued for the balance of the period 10 the beneficiary designated.
Yean Tenn Certain
Amount
Frequency
X INCOME OPTION E: (S-Year Interest Only) This option allows you to place Ihe tala! value of your annuity on depo.it at the
guaranteed rate of interest plus eJ<Ces. intere'l as declared by the Board of Directors. Interest payments can be made 10 you on
a monthly, quancrly, semiannual or annual basis. The minimum interest payment made on any method is 550. If death occurs
during the S-year period, your de.ignated beneficiary would continue to receive the remaining benetits. At the end of the S-year
period you can elect one of the following options: I.) return of Net Value; or 2.) renew for additional S.year interest option:
or 3.) select another oplion. Please keep in mind this option doe. not meet Internal Revenue Service distribulion rules for qualified
accounts.
Amount All intereSlFrequency Monthly
INCOME OPTION F: (Joint and Survivor Tenn Cenain) A lenn of S throogh 2S years is available. Equal payments will be
made to you and the joint annuitant as long as you both are living. In the evenl of death of either joint annuilant, benetits would
continue 10 be paid to the surviving annuilant. In the event of both joint annuilants' deaths during the Tenn-cenain period, benefits
would continue to be paid to your designated beneficiary.
There i. no right 10 select lump-sum payments for Ihe annuilant andlor owner.
Joint and
Survivor,
Years Term Cenain
Amount
Frequency
tNCOME OPTION G: (Benefit Cenain) This option allows you to pick a specific sum of money 10 be received monthly, quanerly.
semiannual or annual. Those benefits would be paid on the frequency you select until the proceeds are e:<hau.ted. DEATH 8ENEffi:
If the annuilant were to die prior to receiving the cenain payments, any such unpaid payments shall be continued to the designated
beneticiary.
Years,
Amount
Frequency
3
\
.
exhibit G
. ....',....,.., ..", W
Attach This Endorsement to Your Policy
JACKSON NATIONAL LIFE INSURANCE COMPANY
LANSING, MICHIGAN
The Policy to which thiJ endoncmcnl is attached is hclCby changed to read and apply as fuUaws, and ceases to apply as
hcrctofurc wriucn:
Policy Number: 0002371630
Name of Annuitant: Mary V, Coyne
Type of Annuity: 5 YEAR TERM CERTAIN, INTEREST ONLY
Date of First Payment: 9/16/91 Frequency: Monthly
Amount of Payments: Guaranteed $935.54, Current $1,949.39
Date of Last Payment: 8/16/96
Death Benefit: If the annuitant were to die prior to having received all payments due under
this contract, payments shall be continued for the balance of the period to the beneficiary
designated in the application. During their lifetime, the annuitant may at any time, by
written request, elect to receive the commuted value of any remaining payments guaranteed
by contract, such commuted value being calculated at 7.5% effective annual interest. After
the death of the annuitant, the beneficiary has the same right of commutation of any unpaid
payments.
Excess Interest: Excess interest, as declared by the Board of Directors of the Company from
time to time in advance, shall be used to increase or decrease the payments. Such excess
interest is not guaranteed and shall not be commutable.
8ased on the current excess interest declaration, the current benefit payable under this
policy is $1,949.39.
This poliCY will be automatically continued after the 5th year unless otherwise requested.
The net value will be used to continue this contract for an additional five years and all
provisions of this endorsement shall apply, except the commuted values shall be at the
original guaranteed rate and excess interest will be based on rate in effect at end of the
five year period.
Commuted value beginning of 2nd year:
Commuted value beginning of 3rd year:
Commuted value beginning of 4th year:
Value at the end of 5th year:
$252,862,30
$260,219.70
$268,128.80
$285,771,11
Except as otherwise provided herein, this endorsement is subject to all the terms,
provisions, and limitations of the policy to which it is attached.
Dated this 17th day of September, 1991.
Form Na. 103 1a7Z
7~~~.~ ~L/
Secretary
EXHIBIT
G
,
..
Exhibit H
(~~
IHIII.... h~' .....
This IS 10 (ccufy Ihial Ihe info~'T1luon here linn is corretely copied from In originll certificate at de.un dUly tUtlJ WHn U1~ .
LOClI R.ulterar. The original, falc will be forwarded 10 the Sellr Villi R.ecc DUic:e for perllUnenc filing.
WARNING: IllaUl~aI to dupUcale \hIe copy by pholoalat Of phOloQraph.
..";-.
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.......
'.....
Foe lur Ihi. ~Ilifjale, $2.00
.--".'
.....
~IoAL""'<L'.: Jj&<Jll~ ,CLM
' Lonl RrSlm.. I
2239812
No.
~~....t;.I.'( l!7y
".MI_ AU
X'- Il<N..-UUHOP......YUNIr.&. OIMIl'MUT 01 HIAU'H. VRIL MCOImI
ceRTIfiCATE Of DEATH
-
..
-.
--
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-...-
--
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..
,-
-
----..-
---
_0
_0
I]
12/6/10
.------
Cwaberland
H.chanic.burg 706 Alli.on Av..
------
.-..-----,
Retired t.acher educatton
-..-....._~-.."-
706 Alli.on Av..
Mechlnlclburq, PA
.
...--...
_o..aa
...
,-
---
--
lIlI1Tild
-
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..
-
....
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-.------
Mary Y. Kenne
-- -~.....
706 Alli.on AVe. Hechanlcsbur PA 17055
1'Ul:a. .....
._-
Cumberland
!I
3
,.
~._",.._..-
Richard J. Coyn.
-
Rlchard J. Coyne
...1lI r-O ......_....a:
. ~a CIM~
Evans ton. I L
,.
..,
M'"
CAlvary Cem.tery
---..
t\nD1/tml !101 H. IlIWntn A..... 1t:~l::ll.ly S
.....- -..
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CERTIFICATE OF SERVICE
I HEREBY CERTIFY that I served a copy of the foregoing
document on all counsel of record by placing same in the United
States mail at HarriSburg, Pennsylvania, postage prepaid, on
January 12, 1999, and addressed as follows:
Mr. Richard J. Coyne
Mrs. Rosemary Coyne
706 Allison Avenue
Mechanicsburg, PA 17055
(Defendants)
<rrtt:1t
REYNOLDS & HAVAS
A Professional Corporation
(3664-199)
5. The underlying facts in the companion case are
substantially similar to the underlying facts which form the
basis of this case.
6. The Coynes are represented by Arthur T. McDermott,
Esquire, in the companion case.
7. On January 12, 1999, Plaintiff filed a Complaint
against the Coynes in this case, As of that time, no appearance
had been entered on behalf of the Coynes. Therefore, the
Complaint was served upon the Coynes.
8. After service of the Complaint was made upon the Coynes
in this case, Attorney McDermott contacted the undersigned
counsel for Plaintiff ("the undersigned") and advised him that he
would not be representing the Coynes in this case. However, he
requested a general extension of time for the Coynes to file an
answer to the Complaint, which extension was granted by the
undersigned.
9. On February 15, 1999, Hubert X. Gilroy, Esquire, wrote
to the undersigned to advise him that the Coynes had contacted
him to represent them in this case. However, he stated that the
Coynes had not yet "formally" retained him, and therefore he had
not yet entered an appearance. A copy of said letter is attached
hereto, made a part hereof and marked as Exhibit "A".
10, In the meantime, counsel for all parties in the
companion case (including Attorney McDermott on behalf of the
Coynes) agreed that the videotape deposition of Plaintiff for use
at trial would be taken in Canton, Ohio (Plaintiff's place of
- 2 -
residence), on March 24, 1999. A notice of deposition was served
on February 17, 1999, by the undersigned upon all counsel,
including Attorney McDermott, in the companion case,
11, Shortly thereafter, the undersigned noticed the
videotape deposition of Ann Harkess for use at trial in this case
for March 24, 1999, in Canton, Ohio. A copy of the notice was
served upon the Coynes by letter dated February 23, 1999. A copy
of the February 23, 1999 letter is attached hereto, made a part
hereof and marked as Exhibit "B", and a copy of the Notice of
Videotape Deposition is attached hereto, made a part hereof and
marked as Exhibit "C".
12. On February 24, 1999, the undersigned wrute to Attorney
Gilroy to acknowledge receipt of his February 15, 1999 letter.
In the letter, the undersigned advised Attorney Gilroy that the
videotape deposition of Plaintiff for use at trial in the
companion case had been notic~d for March 24, 1999, in Canton,
Ohio.
13. The undersigned also advised Attorney Gilroy in the
February 24, 1999 letter that in order to save time and expense,
the deposition of Plaintiff for use at trial in this case was
also going to be taken on March 24, 1999, in Canton, Ohio. A
copy of the February 24, 1999 letter is attached hereto, made a
part hereof and marked as Exhibit "0".
14. After receiving the February 24, 1999 letter, Attorney
Gilroy wrote to Attorney McDermott on March 1, 1999, to advise
him that the deposition of Plaintiff would be taken in both
- 3 -
actions and that ", . . it is my understanding that you will
include in your questions of Ms. Harkess pertinent information
relating to the action at Docket No. 97-0199." A copy of the
March 1, 1999 letter, which is attached hereto, made a part
hereof and marked as Exhibit "E", was sent to the undersigned and
to the Coynes by Attorney Gilroy.
15, Based upon Attorney Gilroy's March 1, 1999 letter, it
was the undersigned's understanding that Attorney Gilroy and the
Coynes had no objection to the videotape deposition of Plaintiff
for use at trial being taken in this case in Canton, Ohio, on
March 24, 1999, and that Attorney McDermott would represent and
protect the interests of the Coynes at the deposition. At no
time up to and including March 23, 1999, the day before the
scheduled deposition, did the Coynes or any attorney on their
behalf object to the deposition.
16. The undersigned received no further communications from
Attorney Gilroy regarding the videotape deposition noticed in
this case until March 23, 1999, the day before the scheduled
deposition, when Attorney Gilroy contacted the undersigned's
secretary and advised her that he was filing a motion for
protective order with the Court that day. Subsequently, Attorney
Gilroy filed with and presented to the Court a "Petition for
Protection Order" on March 23, On the same day, he faxed a copy
of the Petition and a copy of the March 23, 1999 Order entered by
the Court with respect to the Petition to the undersigned's
- 4 -
secretary. By this time, the undersigned had already traveled to
and was in Canton, Ohio, for the deposition,
17. In the Petition for Protection Order, the Coynes
requested the Court to enter a Rule upon Plaintiff to show cause
why the videotape deposition taken in Canton, Ohio, on March 24,
1999, should be used as a deposition for use at trial in this
case.
lB. On March 23, 1999, this Court, by the Honorable Edgar
B. Bayley, entered an Order in the nature of a Rule upon
Plaintiff to show cause "why the deposition of the Plaintiff for
use at trial must be scheduled in Canton, Ohio, for March 24,
1999." Pending receipt of Plaintiff's response to the Rule,
which was made returnable 20 days after service, the Court
reserved ruling on whether the videotape deposition of Plaintiff
taken on March 24, 1999, in Canton, Ohio, may be used as a
deposition for use at trial in this case, and whether the Coynes
may request that Plaintiff submit herself to a deposition for
purposes of discovery in connection with this case.
19. On March 24, 1999, the deposition of Plaintiff for use
at trial was taken in this case and the companion case. JNL also
took the discovery deposition of Plaintiff in the companion case.
Defendant Richard J. Coyne and Attorney McDermott were present at
both depositions.
20. Plaintiff submits that the videotape deposition of
Plaintiff taken on March 24, 1999, in Canton, Ohio, should be
- 5 -
used as a deposition for use at trial in this case for, inter
alia, the following reasons:
A. Plaintiff is a 77 year old woman who essentially
has been confined to her home in Canton, Ohio, for almost twenty
(20) years. She is unable to travel to Carlisle, Pennsylvania,
to attend trial as set forth in letter dated April 1, 1999, from
Ronald A. Shubert, M.D., her attending physician in Canton, Ohio,
A copy of the April 1, 1999 letter is attached hereto, made a
part hereof and marked as Exhibit "F".
B. Because of the time and expense involved in
traveling to Ohio to take Plaintiff's deposition for use at
trial, the undersigned noticed the deposition of Plaintiff in the
companion case and in this case for the same date in Canton,
Ohio,
C. Plaintiff gave notice of the taking of the
deposition to the Coynes, Attorney Gilroy and Attorney McDermott
approximately 30 days before the date of the deposition.
D. The underlying facts in both cases are essentially
the same. Attorney McDermott is familiar with those facts
because he has represented the Coynes in the companion case since
they were joined as additional defendants in that case in 1997.
Attorney McDermott was present at the videotape deposition of
Plaintiff taken in this case. Attorney McDermott could have
protected, and did protect, the interests of the Coynes at the
videotape deposition in accordance with the instructions in
Attorney Gilroy's March 1, 1999 letter to Attorney McDermott
6 -
(Exhibit E), Further, Defendant Richard J. Coyne was present at
the videotape deposition.
E. Although the Coynes, Attorney Gilroy and Attorney
McDermott received notice of Plaintiff's intention to take the
videotape deposition in this case approximately 30 days before
the date of the deposition, the petition for Protection Order was
not filed and presented to the Court until March 23, 1999, one
day before the scheduled deposition and after counsel had
traveled to Ohio and incurred the time and expense related
thereto.
F. For the foregoing reasons, it is respectfully
submitted that this Court should order that the videotape
deposition of Plaintiff for use at trial taken on March 24, 1999,
in Canton, Ohio, may be used as a deposition for use at trial in
this case.
21, Plaintiff submits that Plaintiff should not be required
to submit herself to a deposition for purposes of discovery in
connection with this case for the following reasons:
A. Counsel for JNL took the deposition of Plaintiff
for discovery purposes immediately prior to the videotape
deposition taken for use at trial in the companion case on
March 24, 1999, in Canton, Ohio.
B. Counsel for JNL gave the parties in the companion
case notice that he intended to take the discovery deposition by
letter dated March 10, 1999, a copy of which is attached hereto,
- 7 -
made a part hereof and marked as Exhibit "G", A copy of that
letter was sent to Attorney Mr.Dermott,
C. Attorney McDermott represented the Coynes at the
discovery deposition taken in the companion case and was present
throughout. The underlying facts in the companion case are
substantially similar to the underlying facts in this case.
Therefore, on behalf of the Coynes, Attorney McDermott could have
asked any questions of Plaintiff relevant to this case.
D. As stated above and in the letter of Dr. Shubert
(Exhibit F), Plaintiff is not physically able to travel from Ohio
to Pennsylvania for any reason, including the taking of her
discovery deposition, Accordingly, if another discovery
deposition is taken, counsel would be required to travel to
Canton, Ohio, for the deposition. This would involve significant
time and expense.
E. The questioning of Plaintiff during the discovery
deposition in the companion case on March 24, 1999, was thorough
and the Coynes were adequately represented at that deposition.
Further, Defendant Richard J. Coyne was present at the discovery
deposition.
F. To the extent the Coynes wish to propound
additional questions to Plaintiff in this case, they can do so
through written interrogatories,
G. For the foregoing reasons, it is respectfully
submitted that this Court should order that Plaintiff not be
- 8 -
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"
YJ!lRIPICATION
I, R. JAMES REYNOLDS, JR., ESQUIRE, state that I am the
attorney for plaintiff Ann M. Harkess, I verify that the facts
set forth in the foregoing RESPONSE TO RULE TO SHOW CAUSE are
true and correct based upon my knowledge, information and belief.
I understand that my statements are made subject to 18 Pa.
C.S. ~ 4904, providing for criminal penalties for unsworn
falsification to authorities.
R.@.:!P.:ffJ
Date: tf- '7- 9 C;
Attorney for Plaintiff
ANN M. HARKESS
Exhibit A
Exhibit B
Exhibit c
R. JAMES ReYNOLDS. JR.. ESQUIRE
PA Ana,"_., 1.0. No. 10252
REYNOLDS 10 HAVAS
A P,o'.'~on" COfPQ'ltlon
'01 Pin. Strut
Pan Olfiee 60. 132-
HuneburG. Plnntyh".",. '7101.0932.
17171 238.3200
",<<olney 101 PllN/m"
ANN M. HARKESS
ANN M. HARKESS,
PlaintiC!
ve,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
NO, 1997 . 00199
RICHARD J. COYNE AND
ROSEMARY COYNE. his wire,
Defendants
JURY TRIAL DEMANDED
NOTICB OP VIDEO~APR DRPOSITION
PLEASE TAKE NOTICE that counsel for Plaintiff will take the
deposition for use at trial of Plaintiff Ann M. Harkess before
Court Re~orters of Akron. Canton & Cleveland. officers nuthorized
to admin~ster oaths, at 834 Walnut. N.E., Canton, Ohio 44702, on
Wedne~day, March 24, 1999, at 11:00 a.m. The deposition is to be
videotaped, pursuant to Pa, R.C.P. No. 4017.1, by Court Reporters
of Akron, Canton & Cleveland. and will be simultaneously recorded
by stenographic means.
The oral examination will continue from day to day until
concluded. You are invited to attend and participate n the
examination.
Date: :2 -2- '5 - 7 /
REYNOLDS & HAVAS
A Professional Corporation
101 Pine Street
Post Office Box 932
Harrisburg, Pennsylvania 17108-0932
(7l7) 236-3200
Attorney for Plaintiff
ANN M. IlARDSS
EXHIBIT
C
exhibit 0
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" JAMII Mn'WlOI. JA
JOHN ttAIJAI
MICUAll M .ADOWIKI"
"''''tl14 l ....NkO JR"
'lIOl" t..ROll
.AR..... A P.RONTHAL
l...U.....lI'. .AkIR
MICUIlI J THO....
REYNOLDS & HAVAS
... "'OnlSlOliAl, COlllOUnoli
AnORNEya AND COUNSELORS AT LAW
101 PINE amEET
POST OFFICE BOX 932
HARRISBURG. PENNSYLVANIA 17108.0932
TtLfPHONE
17171 236-3200
FAX
17171236-8883
E-MAIL
r.Vh....O.pi..M1
February 24, 1999
Hubert X. Gilroy, Esquire
Broujos & Gilroy, P.C.
4 North Hanover Street
Carlisle, Pennsylvania 17013
Re: Ann M. Harkess vs. Richard & Rosemary Coyne
Docket No. 97-0199 (Cumberland County)
Our File No. 3664-1
,
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,
Dear Hubert:
I acknowledge receipt of your letter dated February 15,
1999, advising me that you expect to be retained by Mr. and Mrs.
Coyne in the above-referenced matter, and that at that time you
enter an appearance on their behalf. In the meantime, please be
advised that I am g~anting an extension of time for the Coynes to
rile a responsive pleading to the Complaint.
As you probably know, my client, Ann Harkess, has also filed
an action against Jackson National Life Insurance Company and
Prudential Insurance Company of America in Cumberland Count at
Docket No. 97-15. Mr. and Mrs. Coyne were joined as Additional
Defendants in that action by Jackson National Life. The
pleadings are closed in that action and discovery is almost
completed. I have noticed the deposition of Ann Harkess for use
at trial in that action. The deposition is scheduled for
March 24, 1999, in Canton, Ohio.
In order to save time and expense, I have also noticed the
deposition of Ann Harkess for use at trial on March 24 in Canton
in the action filed against the Coynes at docket number 97-0199.
Since the Coynes are not yet represented by counsel, I have
served a copy of the Notice upon them. I am enclosing a copy of
that Notice herewith.
RJR/ms
Enclosure
, -s.incerely, '\
.~~ ~!-CY.,
R. James Re~nol~: jr.
'.
"C.t,tled ...I CIY~ fI,,, Mvoc""l1l' 'N N'hOnal BOatd 01 r",t AdYOCK...
A '""""-'Iv..... S.....__. Co.., A(('IIlI'U,d AO_'"
EXHIBIT
D
exhibit E
J ~1~q
JOliN II UJlOU!()!)
I tU8t:M1 X. GilROY
BROUPS & GILROY, l'.c.
AlTORNEYS AT LAW
4 NORTH HANOVER STREET
CARLISLE, PENNSYLVANIA 17013
TELEPIlONE: (717) 243-1574
FACSIMILE: (717) 243.8227
INTERNET: brgHroypc@aol.com
NON. TOLL FOR HARRISBURG AREA
717-766-1690
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March 1, 1999
Arthur McDermott
251 South Pitt Street
Carlisle, PA 17013
Dear Mac:
Enclosed is a letter I received from Jim Reynolds.
Pursuant to our discussions, it is my understanding that you will include in your questions
of Ms. Harkess pertinent information relating to the action at Docket No, 97-01 99.
,
Hubert X. Gilroy
dr.h
cc: Mr. and Mrs. Coyne
R. James Reynolds, Jr., Esquire
EXHIBIT
E
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RONALD A. SHUBERT, 1\1.0., INC.
3501 TUSC,\RAWAS ST. \I'
CANTON. OHIO 4~70R
13301453,3099
April I, 1999
Re: Ann N, Harkess
SSI/296-07-4134
B,O, 1/23/22
To Whon' It Nay Conce rn:
.
I,
Ronald A. Shubert, H.O.
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lIrs. Ann Parkess is unable to travel outside of home environmer,t
due to her medical condition.
S/ilc;V-
RAS/se
EXHIBIT
F
exhibit G
. .'''''.' ..
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CBRTIPICATB OP SERVICE
I HEREBY CERTIFY that I served a copy of the foregoing
document on Defendants by placing same in the United States mail
at Harrisburg, Pennsylvania, postage prepaid, on April 7, 1999,
and addressed as follows:
Hubert X. Gilroy, Esquire
Broujos & Gilroy, P.C.
4 North Hanover Street
Carlisle, PA 17013
(Attorney for Defendants)
,
Marianne
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REYNOLDS & HAVAS
A Professional Corporation
(3664-199)
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R, JAMES REYNOLDS. JA.. ESQUIRE
PA Allllr/lllV 1.0. No. 10262
THOMAS, THOMAS, ARMSTRONG & NIESEN
AtlOrllllVS ilfld Cot/II!IlIUms nflnw
212 lCICUYt SlflH.I, SlulH 600
Posl Offir:o 8mc 9500
HmrishtJrU. Pennsylvlll1io 171 OH-9500
17111 256 7604
__.___,._________.____M. _ _. _____________._.__~ __________~__________.__.._..____... __
ANN M, HARKESS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
vs,
NO, 97 - 199
RICHARD J. COYNE AND
ROSEMARY COYNE, his wife,
Defendants
JURYTR~LDEMANDED
PRAECIPE TO CHANGE ADDRESS OF COUNSEL
TO THE PROTHONOTARY:
I have entered my appearance on behalf of Plaintiff ANN M. HARKESS in the
above-captioned action. Please change your records to reflect my new address, as
follows:
R. James Reynolds, Jr., Esquire
Thomas, Thomas, Armstrong & Niesen
212 Locust Street, Suite 500
Post Office Box 9500
Harrisburg, Pennsylvania 17108-9500
Telephone: (717) 255-7604
Fax (717) 236-8278
Date: !;' - 1/ - 97
Attorney for Plaintiff
ANN M. HARKE55
cc: Counsel of Record
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that I served a copy of the foregoing document on
Defendants by placing same in the United States mail at Harrisburg, Pennsylvania,
/;1...
postage prepaid, on May i't; 1999, and addressed as follows:
Hubert X, Gilroy, Esquire
Broujos & Gilroy, P.C,
4 North Hanover Street
Carlisle, PA 17013
(Attorney for Defendants)
7
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(3664-199)
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ANN M. IIARKESS,
Plaintitl.
: IN TilE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
v
: NO. 97-00199
RICHARD J. COYNE and
ROSEMARY COYNE, his wilc,
Defcndants
: CIVIL ACTION - LA W
COURT ORDER
AND NOW this '2.1J day of March,~99~~de~~llC~ motion for ~ 1cu..fc.RC
protective order, it is ordered ~ed ll,~l Pla;lIl;ff "Lull show cause why th~ of
the Plaintiff for use at trial must be scheduled in Canton, Ohio for March 24,1999. Pending
receipt of response by the Plaintiff to this order, the Court reserves a ruling on whether the
deposition of the Plaintiff Ann M. Harkess, which is scheduled to be taken on March 24, 1999 in
Canton, Ohio, may be used as a deposition for use at trial in the above case. The Court also
reserves ruling on whether Defendants may request that the Plaintiff submit herself to a
deposition for purposes of discovery in connection with the above referenced case. This order
shall not prohibit the deposition to proceed as the deposition rclates to the Companion Case of
Harkess v Jackson National Life Insurance Company, Prudential Insurance Company of America
~(.l,c,
and Richard J. Coyne and Rosemary Coyne at Docket No. 97 - 15, Cumberland County.
~J1)~.1 r
/lJ(AA cQ '-
BY THE COURT,
7/
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/,.~~////" / J.
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,
cc:
Hubert X. Gilroy, Esq.
Broujos & Gilroy, P.C.
4 North Hanover Street " _
Carlisle, PA 17013 '(l'-"''',<.>..l"",,,<.)..,,\
;\P,\"'l
"
R. James Reynolds, Esq.
Reynolds & Havas
101 Pine Strect . '~'~""\ N"\' ,'" 'IIB\".,
Harrishurg, P A 171 () I
6
Plaintifl's counsel advised Delendants by leller of February 23, 1999 of his intention to take the
deposition of Ann M. Harkess, for use at trial in the above captioned ease, at Canton, Ohio on
March 24, 1999, A copy of said notice of the videotaped deposition and leller is enclosed.
Plaintiff's counsel simultaneously notified the undersigned counsel of the intention to takc said
deposition. However, the undersigned counsel was not fonnally retained by the Defendants at
that time.
7
Defcndants rctained the undersigned counscl on March 23, 1999 to represent them in the above
captioned mailer. The othcr undersigned counsel has entered his appearance by Praecipe.
,
~
I
8
Defendants seek a protective order ITom the videotaped deposition which is scheduled in this
case on March 24, 1999 for the following reasons:
A. Although at the scheduled deposition Allorney McDennoll will represent the
interests of the Defcndants in the Companion Case, Defendants counsel in the
above captioned case is not available to represent Defendant at a deposition on
March 24, 1999 in Ohio.
B. Because the scheduled deposition is more than 100 miles from the Cumberland
County Courthouse, Defendants would be authorized to receive payment of
reasonable cxpenses to allend such deposition, including allorney's fees, pursuant
to Pennsylvania Rule of Civil Procedure 4008. In Plaintilf's notice of deposition,
Plaintiff made no suggestion that Dcfendants would be reimhursed for their
reasonable expenses.
C. The deposition is of the Plaintiff and, as proposed by Plaintiff's counsel, is not a
discovery deposition but is a deposition for "use at trial". The Notice of
Deposition does not suggest any reason why Plaintiff would not be ahle to all end
a trial in the above captioned case and subject herself' personally to examination
hy a Judge or jury.
D. Allendance at a deposition in Ohio by Icgal counsel for the Defendant would
cause an undue burdcn or expense.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that I served a copy of the foregoing
document on Defendants by placing same in the United States mail
, ...;-
at Harrisburg, Pennsylvania, postage prepaid, on February ~,
1999, and addressed as follows:
Mr. Richard J. Coyne
Mrs. Rosemary Coyne
706 Allison Avenue
Mechanicsburg, PA 17055
(Defendants)
'llitJAU'vMcf j~'
Marianne Sottile (
REYNOLDS & HAVAS
A Professional Corporation
13664 -199)
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Commonwealth of Pennsylvania
County of Cumberland
Ann M. Harkess
Court 01 Commoll Plea.s
VI.
:'<0. ___199J_-:199__CiviLTeJ'JO_muum 19m_
Richard J. Coyne and
Rosemary Coyne, his wife
706 Alison Avenue
Mechanicsburg, PA 17055
III ___ _CiviJ...ActioD.._-=_t.aw._ ____uuu________
To uF.iGoom_.],_s.;.QY[I~U!D9_.flQ~~l'l'!n'uGQY!l_~, his wife
You aro hereby notified that
.__________________~D..l1._Houcke~____________.________________________________________________
the Plaintiff has commenced an action in u____1:i\dLAction_=-_la...u_____uu___u_uu___u__
against you which you are required to delend or a delault judgment may be enterod against you.
(SEAL)
Lawrence E. Welker
.------------------p~th~~~t;;y-------------------
Date u__.JanUa.ql._ll...u_uu___u 19..!l'Z
By -----~~~i5~~~~~----------
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ANN M. HARKESS,
plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
vs.
NO. 1997-00199
RICHARD J. COYNE et al.
Defendant
JURY TRIAL DEMANDED
PRAECIPE TO WITHDRAW APPEARANCE
TO THE PROTHONOTARY:
please withdraw the appearance of William P. Douglas,
Esquire, and the law firm of Douglas, Douglas & Douglas, on
behalf of plaintiff ANN M. HARKESS in the above-captioned action.
DOUGLAS, DOUGLAS & DOUGLAS
Date: l, -~ -91
Q.
William P. Douglas, squire
PA Attorney I.D. No 37926
27 West High Street
Carlisle, Pennsylvania 17013
PRAECIPE TO ENTER APPEARANCE
By:
TO THE PROTHONOTARY:
Please enter the appearance of R. James Reynolds, Jr.,
Esquire, and the law firm of Reynolds & Havas, on behalf of
Plaintiff ANN M. HARKESS in the above-captioned action.
REYNOLDS & HAVAS,
A Professional corporation
Date: ~ ~2-r;7
By:
R. a s Reynolds,
PA Attorney I.D. No.
101 pine Street
Post Office Box 932
Harrisburg, pennsylvania 17108-0932
(717) 236-3200
Attorneys for Plaintiff
ANN M. HAlUtESS
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CERTIPICATE OP SERVICE
I HEREBY CERTIFY that I served a true and correct copy of
the foregoing document on all counsel of record by placing same
in the United States mail at Harrisburg, Pennsylvania, postage
prepaid, on June 6, 1997, and addressed as follows:
Mr. Richard J. Coyne
Mrs. Rosemary Coyne
706 Allison Avenue
Mechanicsburg, PA 17055
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"Il-tMifd
rianne Sotti e
REYNOLDS & HAVAS
A professional Corporation
(3664-199)
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ANN M. IIARKESS,
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: IN TilE COURT OF COMMON PLEAS OF
: ClIMUERLANI) COUNTY,I'ENNSYLVANIA
v.
NO. 1997 - 00199 CIVIL
RICHARI) J. COYNE llnd
ROSEMARY COYNE,
I)cfcndants
CIVIL ACTION - LAW
PRELIMINARY OB.JF.CTIONS TO PLAINTIFF'S COMPLAINT
Defendants Richard J. Coyne and Rosemary Coyne. by and through Iheir allorneys,
Broujos & Gilroy, P.C.. rcspectfully file these objeclions to the PlaintifT's Complaint and in
support thereof aver the following:
On January 2, 1997. Ann M. Ilarkess ("lIarkess"), Ihe Plaintiff in the above captioned
aclion, filed a praecipc to issue a writ of summons againsl Jackson National Life Insurancc
Company ("Jackson National") and thc Prudcnliallnsurance Company of America
("Prudential"). This said case was dockcled with this Court at 1997-0015 CIVIL ("Action I").
In Action], on July 14. ] 997, Plaintiff filed a complaint containing Count I: lIarkess v. Jackson
National - Breach of Contract: Count 2: Harkcss v. Jackson National- Ncgligcnce/Intentional
Tort: and Count 3: lIarkess v. Prudential - Ncgligence.
2
In the aforcmcntioned Action I. Harkcss seeks judgemcnt against Jackson National
and/or Prudenlial in an amount in excess of $25,000.00 with interesl and costs of suil, bul
Coynes believc. in essence. lIarkess is sceking the cash valuc ofa Lifc Annuity ("Annuity")
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owncd by Ihc now-dcccascd Mary V. Coync and issucd by Jackson National. in an amounl equal
10 thc cash valuc atlhc timc of Mury V. Coync's dcuth, hud no cash withdruwals bccn made and
which was allcgcdly madc by Ihc Coyncs prior 10 Mary V. Coync's dcath.
3
On Scptcmbcr 5.1997, Juekson NUlionul filcd a complainl aguinst additional defendanls
naming Richurd J. Coync and Rosemury Coync as additional dcfcndanls in thc aforcmcnlioncd
Action I.
4
Richard J. Coync and Roscmary Coync (colleclively, "Coyncs") are husband and wife
and Richard is the ncphcw ofthc dcccused Mary V. Coyne.
5
In iI's Complaint against lhc Coynes, Jackson National allcgcs that if Harkess' claims are
true, Ihc Coynes havc committcd a fruud and are either solcly liable 10 Harkess or liable ovcr 10
Jackson National on Ihc causcs of aClion in Action I.
6
In Action I. on Scptcmbcr 16. 1997. thc Coynes responded 10 the Complaint Againsl
Additional Dcfcndants by filing an Answcr and New Mattcr. On Scplembcr 18. 1997, Jackson
Nalional filcd a Rcply to thc Coyncs' Ncw Mattcr.
7
In AClion I. Prudcnlial filcd prcliminary objcctions to Harkess' Complaint on August 4.
1997. Said I'reliminury Objcctions wcrc dcnied by Ihis Court on January 15, 1998.
8
In AClion I, on Fcbruary 27, 1998. Prudcnlial tilcd an answcr and new mallcr including a
claim against additional Dcfendants.
9
In Prudcntial's Claim Against Additional Dcfendanls, Prudential avcrs thaI if Ihe
allcgations of I-Iarkcss are truc, then thc Coyncs wrongfully arrangcd to rcccive funds properly
belonging 10 Plaintiff, and Prudcnlial requcsts that Ihe Coynes bc found solcly liable 10 I-Iarkess
or liable over to Prudcnlial on Ihe I-Iarkcss causcs of action.
10
On March 19, 1998, thc Coyncs filed an answer to the claim against addilional
dcfendants made by Prudcntial in Action I.
11
Substanlial discovcry has takcn placc in Action 1.
]2
On January 13. 1997, I-Iarkcss filcd a praecipe to issue a wril of summons against the
Coynes. said Praccipe dockeled at ] 997-0] 99 CIVIL, Ihe above captioned action ("AClion 2").
13
In AClion 2, on January 12, 1999, I-Iarkess filed a complainl againsl thc Coynes alleging,
in summary, Count I: Intentional Inlcrfcrcnce with Conlractual Relalions and Counl 2: Fraud.
Thcse Prcliminary Objections follow.
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OIUECTION NO. I . US I'F.NI>F.NS
Pendency ofa Prior Acllon Pursuanllo l'll.R.C.I). 1028(ll)(6)
14
Thc avcnncnts of Paragraphs I Ihrough 13 arc incorporaled hcrein by refcrcncc as if sct
15
forth Icxtually allcnglh.
Harkcss' Action 2 is bascd upon thc same facls and circumstanccs as Ihosc undcrlying
Harkcss' Action I.
16
Thc claims againsl Ihc Coyncs in Action 2 arc, in csscncc, Ihe same as thosc which are
averrcd in AClion I. Ihal is. that Ihc Coyncs fraudulcntly or otherwisc wrongfully causcd Ihe
dcsignation of thc Annuity owncd by a Mary V. Coync to bc changcd from Harkcss 10 Ihc
Coynes, thcrcby dcpriving lIarkcss ofthc dcath bcnclit oflhc Annuily.
17
In both Action 1 and Action 2. lIarkcss sccks an amounl in cxccss of $25,000.00, plus
punitivc damages. intcrcsl. and costs of thc suit. but Coyncs bclicvc. in esscncc, Harkcss is
sceking thc cash valuc of Ihc Annuity al thc timc of Mary V. Coync's dcath, had no cash
withdrawals bccn madc Ihcrcfrom allcgcdly by Ihc Coyncs.
18
As thc partics in Aclion 2 arc advcrsarial partics in Aclion I, and as thc claims againsllhe
Coyncs avcrrcd by Ilarkcss in Action 2 arc csscntially Ihc samc as Ihosc c1aimcd against Ihe
Coyncs in Action I. and as thc rclicf sought hy Ilarkcss in hoth actions is thc samc. Harkess'
Action 2 againsl thc Coyncs is harrcd hy thc doctrinc of lis pcndcns.
24
Harkcss fUrlhcr claims thaI thc bcncficiary dcsignalion documl'nl which dcsignatcd Ann
M. Harkcss as bcncficiary of Ihc Annuity was rccordcd at Jackson Nalionalon Augusl 30. 1988.
which is a full six ycars aner the Annuity was purchascd by Mary V. Coync.
25
As a donec bencficiarv undcr an annuity conlract. Harkcss has no standing 10 claim
inlenlional interferencc with contractual relations as Harkcss was not a party 10 any conlracl
bClwecn hersclfand Mary V. Coyne.
26
Contrary to the allcgation of Harkess. as donce bcneficiary under the Annuily. Harkess
was not in privity of conlract with Jackson National.
27
I-Iarkess fails 10 avcr any agrccmcnt or provision thercof which would have prcvenled
Mary V. Coync or Jackson National from changing thc bencficiary of the Annuily, but rather
simply claims thaI doing so was wrongful.
28
Abscnt considcration paid by I-Iarkcss and/or an agrccmcnl to Ihe conlrary. Harkess is
without slanding to objcct to anv changc of bcncficiary of the Annuily.
WHEREFORE, Dcfcndanls Richard J. and Roscmary Coync respectfully requcst Ihal
this Honorablc COUrl cntcr an order dismissing Plaintiff's Complaint wilh prejudice.
R James Revnolds. Jr , EsqlJlfe
PA AItOlnev I 0 No 10252
Thomas, Thomas. Arnlstrong & Niesen
At10rneya and Counsellors allaw
212locusl Street, SUlte500
Post Olflce Bolt &500
HII'risburg. Pennsylvania 17108-9500
1717) 255-7604/FAX 1717)236.8278
Altornev for Plaintiff
Ann M. Hsrkess
ANN M. HARKESS,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
RICHARD J. COYNE and
ROSEMARY COYNE, his wife,
Defendants
No. 97 - 199
JURY TRIAL DEMANDED
PRAECIPE
To the Prothonotary:
Please mark the above captioned action SETTLED, DISCONTINUED and ENDED,
with prejudice.
- (. ') J
Date: {_{ I. ",-00'
By:
Thomas, Thomas, Armstrong & Niesen
212 Locust Street, Suite 500
Post Offir.e Box 9500
Harrisburg, Pennsylvania 17108-9500
(717) 255-7604
Attorney for Plaintiff
Ann M. Harkess
CERTIFICATE OF SERVICE
I hereby csrllfy that I have served a true and correct copy of the foregoing
Thomas, Thomas, Armstrong & Niesen
document on all counsel of record by placing the same in the United States Mail at
Harrisburg, Pennsylvania, first-class poslage prepaid, on Ihe j<,i,{/ day of May, 2000,
addressed as follows:
Hubert X. Gilroy, Esquire
Broujos & Gilroy, P.C.
Four North Hanover Street
Carlisle, Pennsylvania 17013
(Attorney for Defendants)
By:
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Sharon Dell-Gallagher,
Secretary
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