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Home My WebLink About05-4479 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CRAIG A. HATCH, EXECUTOR OF the ESTATE OF JANE T. BENDER and: the ESTATE OF RICHARD B. BENDER,: Civil Action-Law Plaintiff, No. OS- - "11./79 Clc)~ L'TfJ/-YY) v. PRUDENTIAL FINANCIAL, INC., a foreign business corporation, d/b/a THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Defendant. JURY TRIAL DEMANDED NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 Telephone No. 717-249-3166 Gates. Halbruner & Hatch, P.C, By: Byron L. McMasters, Esquire PA Attorney 10 No. 92410 Albert N. Peterlin, Esquire PA Attorney 10 No. 84180 1013 Mumma Road, Suite 100 lemoyne, PA 17043-1144 (717) 731-9600 (717) 731-9627 facsimile b. mcmasters@qateslawfirm.com a. peterlin@qateslawfirm.com www.qateslawfirm.com IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CRAIG A. HATCH, EXECUTOR OF the ESTATE OF JANE T. BENDER and: the ESTATE OF RICHARD B. BENDER,: Civil Action-law Plaintiff, No, DS - ~/'{79 f!t~L~ttIUY) v. PRUDENTIAL FINANCIAL, INC., a New Jersey business corporation, d/b/a : THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Defendant. JURY TRIAL DEMANDED COMPLAINT Plaintiff, Craig A. Hatch, Executor of the Estate of Richard B. Bender and the Estate of Jane T. Bender, by and through his attorneys, Gates, Halbruner & Hatch, P.C., hereby complains against the Defendant, Prudential Financial, Inc. d/b/a The Prudential Insurance Company of America, and in support thereof avers as follows: 2 I. PARTIES 1. Plaintiff, Craig A. Hatch (the "Executor"), is an adult individual residing at 21 Meadow Drive, Camp Hill, York County, Pennsylvania, 17011, and is the Executor of the Estate of Richard B. Bender and the Estate of Jane T. Bender. 2. Defendant, Prudential Financial, Inc. is a New Jersey corporation with its principal place of business at 751 Broad Street, Newark, NJ 07102-3777. 3. Prudential Financial, Inc. sells its annuities through The Prudential Insurance Company of America, a division of Prudential Financial, Inc., with its principal place of business at 751 Broad Street, Newark, NJ 07102-3777. 4. The Prudential Insurance Company of America utilizes local branchlfield offices to sell its annuities to its clients, one of which is located at 150 Corporate Center Dr., Suite 105, Camp Hill, Cumberland County, Pennsylvania, 17011-1759. II. JURISDICTION AND VENUE 5. Jurisdiction is proper pursuant to 42 Pa.C.S.A. ~ 931(a) where the instant action involves substantial state questions. 6. Venue is proper pursuant to 42 Pa.C.SA ~ 931(c) and Pa.R.C.P. 2179(a)(1) where Defendant's registered office is located in Cumberland County. III. INTRODUCTION 7. This case sounds in breach of fiduciary duty and negligence on the part of Defendant. 8. Factually, this case centers on Defendant's failure to provide Plaintiff's Decedents, Richard B. and Jane T. Bender Uointly, "Benders"), with proper advice 3 IV. BACKGROUND 15. In or about February of 2002, upon information and belief, Andrew Grace, a representative of Defendant, provided financial advice to Richard Bender and Jane Bender regarding the investment of their $100,000.00. 16. To aid Defendant in determining suitable investments for the Benders, on or about February 15, 2002, Richard Bender completed and signed a "Customer Information Form" provided by Defendant, wherein he noted that his "Investment Objective" was "'ncome," and his "Risk Tolerance" was "Conservative." See attached Exhibit "A." 17. Thereafter, on or about February 15, 2002, Richard Bender, as "owner." and Jane Bender, as "joint owner," completed a "Prudentiallncome Annuity Application." See attached Exhibit "B." 18. As a result of the submission of the Prudential Income Annuity Application, the Benders received an annuity contract, on or about February 19, 2002, the material terms of which are that for a purchase price of $100,000.00, the Benders would receive $778.07 per month from Defendant, starting March 15, 2002, and continuing until the death of the second spouse to die. See attached Exhibit "C." 19. At the time the Benders purchased the annuity. Richard Bender, born October 18,1926, was age seventy-five (75), and Jane Bender, born November 23, 1923, was age seventy-eight (78). 5 35. The Benders suffered damages as a result of Defendant's negligence, i.e. loss of money not recouped by the monthly payments and loss of opportunity to make an investment consistent with their stated objective. 36. Defendant caused the damages suffered by the Benders by providing poor investment advice. 37. Defendant's conduct was willful, outrageous, and showed a reckless indifference to the rights of the Benders. Wherefore, Plaintiff, Craig A. Hatch, Executor of the Estate of Richard B. Bender and the Estate of Jane T. Bender, demands judgment against Defendant, Prudential Financial, Inc. d/b/a The Prudential Insurance Company of America, for damages of Seventy-Three Thousand Five Hundred Forty-Five and 62/100 Dollars ($73,545.62) plus punitive damages, attorneys fees, costs, interest, and such further relief as the Court deems just and proper. Respectfully submitted, GATES, HALBRUNER & HATCH, P.C. By: ~~ Byron L. cMasters, Esquire PA Attorney ID No. 92410 Albert N. Peterlin, Esquire PA Attorney ID No. 84180 1013 Mumma Road, Suite 100 Lemoyne, PA 17043 (717) 731-9600 (Attorneys for Plaintiff) Date: 'D" JG . 05 9 VERIFICATION I, Craig A. Hatch, state that I have reviewed the foregoing Complaint and verify that the facts contained therein are true and correct to the best of my knowledge, information and belief. I further verify that these statements made by me are subject to the penalties of 18 Pa.C.SA S 4904 relating to unsworn falsification to authorities. Date: 1: 4;.t,. (Jeo':) Cra' A. Hatch E ecutor for the Estate of Richard B. Bender Executor for the Estate of Jane T. Bender rrU<1ential ~ l_.ancial Customer Information Form Prudentiallnsuranee Company of America Prveo life Insurance Company of New Jersey Pruc;o Life lnsuranc& Company All are Prudenfial companies. Explanation This form must be returned with your application. Industry regulation requires us to obtain certain Information in order to determine the suitability of this annuity. Please complete all sections of this form. DCustomer Information Owne(s First Name 1\2, \ .r hlA.f".~. . . . SS#lTIN (Taxpayer Identification #) I \.l.d.~.t+. '7.'7.9.81 Employer I . . Marital Status U Single MMarried Education Lever Achieved U Post U College Graduate Work Graduate Why are you purchasing this annuity? U Retirement Savings 0J Other: -=tts. C D Vh e M.1. Last Name . , I ~ ~ fL(,\.d., t,(, Occupation (if retired. please state) IRe-.\..'\ \' {' .d. , . . , . . I No. of Dependents liLQ Age U WidowedJDivorced [L,2l U Attended College ~i9h School U Attended Primaryl Graduate High School Type of Annuity U Qualified UTechnicalor Vocational School ~Non-Qualjfied DHousetlOld Ranges: Annual Household Net Uquid 1 Annual Income: Owner's Fina~1 Income 1 Income2 Worth 3 Net Worth' income from all sources, Info ion Up to $24,999 rs tpr u U before taxes. ... 2 Household Income: All t.- $25,000 - $49,999 U U U U members of the household 0 $50,000 - $74,999 U U U U contributing income fiom all sources, before taxes. 'j $75,000 - $99,999 U U U U 3 Net Worth: The amount by ~ = U U U U which assets exceed 1 $100,000 - $149,999 liabilities. For an individual it 8 $150,000 - $249,999 U U ~ ~ would be the total value of all $250,000 - $499,999 U U U U possessions, such as a 1 house, stocks, bonds, bank j $500,000 - $749,999 U U U U accounts, minus all . U U U U outstanding debts, sucll as . $750,000 - $999,999 mortgage, loans and credit " ~ $1,000,000 $2,499,999 U U U U card balances. 1 - 4 liquid Net Worth: That part $2,500,000 - $4,999,999 U U U U of a person's net worth held in 2 $5,000,000 $9.999,999 U U U U cash or easily convertible to U, cash such as money market ~ $10,000,000 ~ $24,999,999 U U U U fund shares, bank deposits, H $25,000,000 or more U U U U mutual funds or other l~ marketable securities. = a. After purchasing this annuity, will you have sufficient ~ 1fT Yes Q liquid assets to meet a financial emergency? UNo ; . b. Are you contributing to your available qualified plans n '" (e.g., 401(k), 403(b), IRA, etc.)? If no or if pian is not .... UNo L:f[Pfan not available !j available, explain in Section 7 (Clienfs Signature UYes 1 and Remarks). Securities are offer~ through Pruco Securities Corporation. a Prudential company. ORO 97185 Eo.5/2. PIl9' 1 of 2 g Home Office copy r. Years of Investn .=xperience (please indicate the number of years or experience in any of the following that apply): None C><~ Equities: Bonds: Options: Futures: Mutual Funds: Variable Annuityllife: Risk Tolerance (check one): ~conservative: Prefer little risk and low volatility in return for accepting potential lower returns. Minimizing exposure of principal to loss or fluctuation is very important. U Moderately Conservative: Willing to take some risk to seek enhanced returns. Reduced exposure of principal to ioss or fluctuation ;s important. U Moderate: Willing to assume an average amount of market risk and volatility or loss of principal to achieve higher returns. U Moderately Aggressive: Willing to assume an above average amount of risk and volatility or loss of principal to take advantage of potentially higher return opportunities. U Aggressive: Willing to sustain substantial volatility or loss 01 principal and assume a high level of risk in pursuing higher returns. Dlnv~stl'!'ent U Preservation of Capital: Seeks to preSfJlVe the value of your investment through all market conditions with a Objective preference for holding cash and/or cash equivalents (e.g., money market funds, CDs, treasury securities with (Seleel up to ~1I0 maturities of one year or less), r~~~~t~~~' lfJlncome: Seeks to earn income through holdings of bonds andlor income yieiding securities, choice as 1 and U Growth: Seeks to achieve growth of capital through investment in securities. second choice, jf any, as 2.) U Diversifled: Investment options selected confonn with recommendations of company approved Asset Allocation Model or 100% is allocated to the Conservative Balanced or Flexible Managed portfoliO (May not be available for all products). I will pay for my initial investment in this annuity through my: U Life Insurance (if selected, please specify death proceeds, dividends. cash value, etc.): rp:J CDs/liquid AssetsiSavings U Mutual Funds U Rollover (from): U Other: Tentatively, 1 plan on making additional investments in this annuity. ~ During the first year, my total additional flrst year payments planned are: $ / I will pay for these additional payments through my: U Life Insurance ~(selected, please specify whether through death benefit proceeds, dividends, cash value, etc.): U CDs/liquid Assets/Savings U Mutual Funds U Annuity U Rollover (from): U Other. f1Risk Tolerance IIprenllum Paynumts o " !.. - 13 2 - 1 S 1 "" ;j . mAgent~ Signatl're and . Remar.~s '- ,. i' ~ 4 It Client'S) Signat4fe and f,1 Remari ... 1 o H q ORO 97185 Ed. 612001 U Annuity Remarks: This application is submitted in the belief that the purchase of this contract is appropriate for the applicant based on the information furnished and as reviewed with the plicant. Date OJ-IS- (] Print Name Office Tel. n ) Registered No.afRep. . !S'-!iI-6'7J Re resentat/veS! nature Were the seleclions based on an Investment Allocation pursuant to a company approved Asset Allocation Model? Remarks: U Yes ~o I acknowledge that the information provided on this form Is accurate to the best of my knowledge and in accordance with my financijl) ob'ectives and anticipated needs. Date 'd- -I '5 - () ;). Print Name I., ( L . . f5e,.J:f. e Client Si nature pag. 20f 2 Home Office copy -. ~ Prudell"laI -- Cheiil< all that 4 apply: '__' 'X; nAnnijitant First Name This s~tionmust 1__ -' ~_,_ _... _ -'_ _.... _ -' __'_ _.L __._ _ '- _.J __'_ _! I : be coiJtpleled only Street if: 1) Me Mnuitan! . is not tpeOYJner, 1.._-' - _.__.. - --'_ _'- - -'_ ~I__... _-'__I... _.J _ _'_ _.. _ -'_ _.... _oJ _ _'__ J. _ -'_ _,--_... __'_ _.. _-'_ _L. _.J _ _'_ _ J._-'_ _L. _ -,__I or 2) ~ Owner City State ZIP Code , listedgpoveisa ~_"'__I__J._....I.._L._.J__'__J.__I__'-_"'__'__i__',...._...._-,__, :__-'__: L_-'__'__L_-,__I L_-,__.__J.__' non-n~lura! person SS#fTIN {Tax Identification No.) Date 01 Birth lmu., UdY, yt;cif) Alca ~vd;; -:'':!8phcne Number ~~~~n~~ ~ _.J _ _,__~_ -'_ _ t.. _ .J_~I__ J. h' :_ _ -'__:_ _J. _ _:_ _\._.1_ _'_ _; {~_ -' __,__ ~} :_ _-'__,__; ~_ -'h',-.L __, C~. k all that Male Female U,S, Citizen Resident Non-Resident Country Alien Alien qapply:". , I' I 1_ _} L _ J L _ ,_ _ J ,_ __I Owner Infonnation this section must be complete<:! in its entirely, 2 o Checfjall that ~ apply: Joilit"Owner (iranYlQ Joint ~ers who a~not spau should consul .th their tax aaV,lSer. 1 3 j 1 ORD"B-no-g9PenMylvania Prudential Income Annuity Application Prudential Annuity Service Center PO Box 13379 Philadelphia, PA 19101 Please print using blue or black ink. 'XJ individual :- ~; COrporation First Name/TlUstee(s) :_R ~ _,~))o~ j:: "~_~_. _"_ _ c _" _-_,_ _: Name of T IUsVCorporationlOther (ff applicable) Application for an Income Mnuity ContJ-oCt 10 the Prudential Insurance c<>mpany of America, 751 Broad Street, Newark. NJ 07102 hereinafter refemad to as 'Prudential"). MI. :_-j Trust ~_~ Other ------------~---. Last Name S"{.._,D.cLt..(" __~ _. _"_ _c_"_ _'__._"_ _c_; ~~ , . L_~__~_L_~__~_~__'__L_~__~_~__~_L_J__L_~__~_L_~__L_~__I__L_~__L.~__~_L_~__L_~__ Street ~3" ~.~. _ "~c _ "J._f:.\.L _cs.-t-_,_( .L.k {." _ _,_ _ .fLQJ:" _ _~'S. Q"~c." _ __... _"_ _c _ "__: C~ S~e ~p~ ~""'-~CC~..s}'O.._u.L.qc."._'__h"__C_"__: ~p.f\: ~\JJ3LL:. ~.._.~_h_: SS#IT1N (Tax Identification No,) J Date of Birth (mo" day, year) Area Code Telephone Number :_~"~ta;~"~_:J.J.:1J_: ~~.L:{.H~,1~L~J~; (~J.L1:) :/}.3.,'i_; - ~?L_'tl_: Relationship to Amuffant (If other than self) L_~__'__L_~__L_~__~_L_~__~_~__'__! Male Female U,S, Citizen Resident Non-Resident Country Alien Alien :2<:- , , ::>.<; , . , . L_J L_J I._J L_~__~_~_~__L_J__,__~_~__~_~__~_~_J Last Name C1~~_~.~ "~J..__~_._"_ _L_. _..._. _"_ _c_; Street ~9~.~. _ j\~ c _ "~,f:\.~"_ _ :;,}_,_<: <~"_~ 1. __,!\~d'_c _. ~J! <.~L _c _" _ _L _ <_"_ _. _ "__: ~ ~ ~~ c~~ ~,_I'.. L\ _ .S}o,.'-J. L9. ___ __ _ __ _ :9.(:\~:_ \ "'"J._\..DJ_: . :- -"- -'--' _.: SS#fTIttrax Identification No,) J Date of Birth (mo. day. year) Area Code Telephone Number :fH~_~_~1"K:_Q5l.~<Q_: ~'L:i!.:J_:_L'?-?J; (~2L7) :!!&~; - ~SJ,(Lf~ Relationship to Annuitant (If other than self) mt Name MI. ~~.>o....0..~...__.._..__,__~_-"__.._..__.__~ ~ , L_"__~_~_"'__L.~__~_~_~__L_~__~_! Male Female U ,S, Citizen Resident Alien Non-Resident Alien Country ~ , I__J , ,_ _ -' _ _'_ _ ~_....._ _L_ --'_ _'__ L _ J__L _~_ _,_ _ L__' MI. Last Name ,_ _ ..I _ _'_ _ ~ _ J _ _... _ ... _ _'_ _ ~ _ -' _ _ L _ J _ _'_ _ -L . -" _ _ '- _ } '---'--'- . L ~ -' _ _'_ _ c _ ' ~ _ ..J_ _ L _" _'_ _.. .'_ Ed.7J10c0 - Anhuitant (ilany) Check all illat apply: I Beneficiary If you need more ~fl/ease enter 11>0 additional infoonation. Including name(s), relalionship{s), SS#mN and Ciass Designation in 'Oienrs Additional Rema<Es'. See sectio{if2. o 2 o 2 - 1 g lVII. J..dS(l'Iam , , , '...._...._ .'_ _ L _-'_ _'- _ -J_ _'_ _.. _ -'__...._-' _ _'- _.' ~ _J '-- _ -'_ _._ _.l._...l_ _'--_...1_ _,_ _.l._ -'__...._...._ _1__'" _....__...._.' Street , - ' L _ ..I _ _'- _ ..I. _ ..J_ _ .... _ ... _ _,_ _ ... _ _' _ _... _ .J _ _._ _ ... _ ....1_ _.... _ .J, _ _._ . L _ -'_ _... _ -' _ _ '- _ ... _ -'_ _ '- _ ..I _ _'_ _ L _ ....1_ _.... _ ...I _ _, City State ZIP Code , I I 1_' f ,_ _ ..l__'__"- _ ..J__...._... _ _.__..._....1_ _.... _-'__'- _ L_ ....1__... _..l__' '- _ -' __, '-. --'- -'~ -... - -,--' 1.._... - _'__L__' SS#/TIN (Tax Identification No.) . Date of Birth (mo., day, year) Area Code Telephone Number , '...._-'__'-_L_....I__~_...I__'-_~_~ I \, , I.. _... _ _,_ _... _ _,_ _'- _...I _ _._ _ 1 ( :- - -' - -.- _.:) , . -' , '- _... _ _'_ _! !... _.J _ _,_ _... __, Male Female U.S. Citizen Resident Non-Resident Country Alien Alien , , , , , , , , , , '- _.! L_J !.._J ' , '--__' '-_...I__~_L_....I__L_..l__~_L_""__""_...I__'-_L_~ Full Name (first, middle initial, last), or Name of Trust, Corporation or Entity , L _ ... _ _'_ _ ... _ .... _ _..... _ ~ _ _'_ _ .L _ ..J _ _ .... ~ ... _ _._ _ ... ~ ...._ _..... _ .. _ _'_ _ .L _ ...l_ _.... _ ... _ _'_ _ .L _ ...l_ _ L. _ .. _ ~'- _ ..... _ ...l. _.... _.. _ _, Relationship to Annuitant SSIIITIN (Tax Identification No.) Primary Class 'X, L_J , I! I' I L _... _ _L. _ L _...._ _ '-_ ,.1__'_ _ 1o._...J_ _'- _.>_ _I- _ J l__... _ _"-_ i _ .....__l... _ -'_ _<- _ L. __, Fun Name (firnl, mjjdle ini1ial,Ias\), or Name of Trust, Corporation or Entity , ' ... _... _ _'-.... _ -'_ _1.._... __'-_" _ -'_ _'- _... _ _,__" _...._ _.. _... _ _._ _.L_......_ _.... _.... _ _,_ _.L _ -J_ _L. _... __.... _.L _....l_ _...._... __, Relationship to Annuitant SS#ITlN (Tax Identification No.) Choose Pnmary SeCOl'ldary one: Class Class , ". I r I ,__...__...._.L_->__...._...__.__-'-_...__L._...__'-_l '__-,__,_.l_-,__!.-_-,__.__,-__1 l__J '___I Full Name (first, middle initial, last), or Name of Trust Corporation or EnMy , ' L_-, __....._... _ -'__L. _... __'__.L _-,__L _J_ _'__... _->__,-.... __._ _ .L_...J__.... _ -'_ _'_ _.. _-'__...._...__.... _...._ ....w_'- -",__' Relationship to Annuitant SS#lTIN (Tax Identification No.) Choose Primay Secondaly one: Class Class , , , , L _..! ' , I r I \ 1 t to _..l __.... _... _......_ _.... _-' _ _'- _.. _ -'_ _... _... _ _'_ _ J '__.. _ _'_ _1. _ ->- ->- _... __"- -... --' FuU Name (firs~ middle initial, last), or Name of Trust, Corporation or Entity , ' !..._.. _ _._ _.. _....._ _L _.._ _'_ _.. _ .....__ L_ J _ _'_ _ J,. _...J_ _'-..J. _ _._ _.. _....._ _.. _... _ _._ _... _....._ _'- _..I __'- _.. _..~ _ L _...__1 Relationship to Annuitant SS#ITlN (Tax Identification No.) Choose Primary Secondary one: Class Class '- - .. - -,~ - ~ - -. - - Iryp_Lf Plan Please "S"' choose one: . Dsou..6e of Fun~ Minimum 01 $3500. ;;: n nPaym)mt Mod~ 4 " ""} '3 . D G 1 . f1 e 1;; ORO~9().9; PfMsyNanIa ~~No~Quafi~ ~_;TNKfl~IRA ~ . ; Custodial Acet Amount Non- Qualified: :__; 1035 Exchange ~)(fCheck - payable to Prudential $ ~." u,.LOJ?' lJf;).,9..; . ~()/J.: IRA/Qualified: ~ _ ; IRA/Qualified Rollover ~. J Direct Rollo>rer ~.; IRA/Qualified Transfer Please :. _ ; Annual ~ _ ; Semi-Annual : : Quarterly , Y7. _: Monthly choose one: - - . - 'f"" J Amount of each payment: $~."._,__.."__]"1.,_'?;. 'P"7..: Date of First Annufty Payment (mmlddlyear): Q"~_:_ ~ ~: i!/-! /J_,i1:~ The first payment date must be 00 later than one year after the purchase of Ihe contract in NY, MA, MI, OR and WI. In all other states, the first payment date can 00 any time up to twenty years after the purchase of the contract. but may not be deferred beyond age iO. Ed.7noo<l :_ _ ; Life Annuity witlllnstallment Refund ~ _ ; Life Annuity witll designated period ot - - - - - - number of payments certain JC Joint and Survivor Ufe Annuity: /. ctO_ % to primary annuitant; J.t~Q _ % to secondary annurtant; ~ _ _: Joint and Survivor Ufe Annuity with installment refund: _ _ _ _ _ _ % to primary annurtant; _ _ _ _ _ _ % to secondary annuitant, ~ _ ; Joint and Survivor lrte Annuity with period certain ot _ _ - - - - number of payments certain: _ _ _ _ _ _ % to primary annuitant, _ - _ _ - - % to secondaly annuitant; If one of the Joint and Survivor options is elected and 100% is the percentage entered for the primay annuitant. that pen:entage is the joint payment percentage to be paid while both the primary and the secondary annuitants are living and then to the primary annuitant ~ the secondary annuitant should die first The percentage entered for the secondaty annuitant is the payment percentage to be paid to the secondary annuitant if the primary annuitant should die first Please note: If you choose 100% paid to the primary annuitan~ you may choose any percentage paid to the secondary annurtant If you choose a percentage less than 100% paid to the primary annuitant, you must choose the iden~cal percentage paid for the secondary annuilant (e.g., 66% to the ~rimary annu~ant and 66% to the secondary annuitant). That payment percentage will be paid while both the primary and the secondary annuitants are living and then to either surviving annuitant Unless a period certain option is elected, after the death of both the primary and secondaty annuitants. a/l payments stop. , . N9te: When a fife option is elected, proof of the da1e of birth of each annuitant must be submitted with the application j (e.g., birth certificate. passport, etc.) 1 ftlRe~2cement A. Will the proposed contract replace any existing insurance or annuity contract(s)? ~ _; Yes r-c:.NO ~;gl:jl9alion If yes, provide the following information for each contract(s) and enclose all applicable Thl t. Prudential disclosure and state replacement forms: S<llec ,on Company Name musllbe com~et..d. It you iJled more Year of Issue space-ry>Jease en ter 1I\e addiU . aI . f--'ll . ~ m VWQ::~lIon In Ute 'Clien~ AddmohaJ ' , ~:~~$~.See '--, - -'--' - -- -" -" --,--. --' '" , - Add';~~- (f you need mor~ space, please enl81 the additional iflformatiOll, in 1I\e 'Clienfs Additional Remarks'. See section 12. imPayment Options 2 i1 [:\ ? - o ? '- 1 8 , L 3 ()RI)f,t.l9C-99~tUylV"..m . .." .....~J . ...} "" .....,<;l.v.OV ~v. First Name MI. Last Name \ \ , ) L_~__~_~_~__L_~__'__~_~__~_~__~_! ~_J L_~__~_~_~__L_~__~_~_~__L_J__~_~_~__L_J Fin~nciaJ Institution' (if applicable) , '-_-' __'__J.. _ -'_ _L _-' _ _'_ _ j.. _-'__L_">' __,_ _... _--'_ _L _-' _ _._ _.. _-'_ _L_-' _ _'. _.._ -'__L_.J _ _'__ J. _-'_ _L~'" __I Street , L_.... .'_ _.l. _-'__L _ oJ _ _'_ _ J._...J_ _........>.__,__.. _ -'_ _.... _-' _ _._ _ '-_-'_.'- _.._ _'- _.. _ -'__L _"'__'__ J. _...J_ _L _-' __I ~ ~ ~~ I I 1 I I 1_ I '- _ ... _ _'_ _ ).. _ -' _ _.... _ -' _ _'_ _ .. _ -' _ _ L __... _ _._ _ .. _ -' _ _ L _ ... _ _, ,_ _ .. _ _, '. _ ... _ _'. _ ... _ -' _ _ I L - ... _ _,_ _.. - _I . AccountlContract Number at Financial Institution , ' L_... __,__ ,,~"'__""_.,) _ _'__" _..,)_ _'-_.J __._ -... --'--'--... --' Please choose one: :- - ; Designated Period:- - - - - - number of payments certain ~ _ ; ute Annuity Policy/Contract Number , ' '-~... _ _'- _.. _ ->__'- _ ~ _ _'__.\, _..J_ _'-_.... __.__... _ ->_ _'- _.... _ _'- _..__I , '-_....__'-_.._->__-...._....__~_.\,_J Plan , , '- -..I _ _'_ _->- __, , ' '-_....__.__..._...._....._...__'-_..._->__1 B. Did you purchase a non-qua~fied annuity from Prudential or an affiiiated company this calendar year? If yes, ~st contract number. Policy/Contract Number " , )(;': L _ J Yes '{-'"' No Ed.7rlOOO mSignatureSI Authoriza. tions 2 o o 2 e~ sen(lltive's SigQilture 1 g 1 3 . c: -- 1 .~ <: 4 . .. ... , it '7 q . o n p 1 > C; U o .., I ORD91l490-$'l. Pel'\C\~y!'l;If>Ia "")' I-'"r>>o' no KnowmglY and with intent to dl ud any insurance company or other pers, files an application for insurance Oi "tatement of claim containing any materially false information or conceals for the purpose of misleading. information concerning any fact material thereto commits a fraudulent insurance act. which is a crime and subjects such person to criminal and civil penalties. If applying for an IRA, the Owner acknowledges receiving an IRA disclosure statement and understands that he or she will be given a financial disclosure statement with the contract The Owner understands that tax deferral is provided by the IRA, and acknowledges that he or she is purchasing this contract for its features other than tax deferral as described in the product brochure. No representative can make or change a contract or waive any of the company's rights or needs. The Owner(s) believes this contract meets hisil1er needs and financial objectives. It is agreed that the contract will take effect on the date the purchase payment is received in Prudentiars Annuity Service Center, even ff the annuttant or joint annuitant died after that date but before the contract is issued. It is understood that the purchase payment becomes the absolute property of the company. Your payment right is limtted to the payout option elected in section 10. Once your contract is issued, you cannot change the payment option thai you selected. ~ If this contract has a Joint Owner, please check this box 10 authorize Prudential to act on the instrucllon(s) of either the Owner or Joint Owner with regard to transactions under the contract CHent's Additional Remar1ls ~---------_._------------------------------------------------------------------> >_ >___l~->- er's Signature (if applicable) _ _______> _ _______ ________ m__Ie.-'!_._~I!_"__":!_____ Annuitants Signature uitants Signature (if applicable) Do you have, from any source, facls that any person named as Owner or Joint Owner above is replacing or changing any current insurance or annuity in any company? If Yes, provide details ~ below. f~J No ~ _ ~ Yes This application is submitted in the beliel that the purchase of this conlrecl is appropriate for the applicant based on the information furnished and as reviewed with the apprlC3Ilt. Reasonable inquiry has been made 01 the Owner concerning the Owner's overall financial situation, needs and investment objectives. ,he representative hereby certifies that all information contained in this applicatJon is true to the best of ~~~.:tQ-_ Bra_ ~ _ ___ __ _ __ _ _ _. ~=n=~er ~-C~,_~ ?:?acO; Nam~rin;( f} )) _~_U0:::-4/L __________________m Signature G _ _ _ _ _ _ ~ _ _ _ _ _ (q ~_ !~!!([skI[VJ _ _ _. BranchJField Office Name "1)e~-,-> - g _&c~_w.!-!_e_ - - - -- - - - - -. Seco esentative Name (ff any) {Print} seCOnd-1preseJ;illte~- - - - - - - - -. Representative's Additional Remarks ~~---__________. :7z?~~?~:'~~__ Branchifield Office Code Telephone No. 2nd Representative Contract Number :X.)]iU_'l; Mail To: Prudential Annuity Service Centcr Overnight: Prudential Annuity ServIce Center PO Box 13379 2101 Welsh Road Philadelphia, PA 19101 Dresher, PA 19025 Questions? Clients call (88S) 778-288B (toll free) Agents call (BOO) 843-4124, Financial Advisers call (S77) 321-5463 E<mooo Prudential ~ Finan' . . - The Prudential Insurance Company of America Newark, New Jersey 07102 Annuitant(s) Sex Date of Birth RICHARD B BENDER JANE T BENDER M F November 8, 1926 November 23, 1923 Contract Number PIA000000828-A Contract Date February 19, 2002 Annuity Payment Date March 15, 2002 Purchase Payment $100,000.00 Owner RICHARD B BENDER Subject to all the provisions of this contract, we will make all payments as stated in the payment schedule. Unless we have endorsed the contract to say otherwise, we will make the payments to the owner, We show the amount and due date of each payment in the payment schedule, This contract does not have a cash value, Please read this contract with care, If there is ever a question about it, just see a Prudential agent or get in touch with one of our offices, Right to Cancel Contract.- You may return this contract within 10 days after you get it. All you have to do is lake the contract or mail it to one of our offices or to the representative who sold it to you, It will be cancelled from the start and we will return your money in accordance with state law, Signed for Prudential. ~~- ~.-aQ * ~7F~ Presi dent Secretary' Annuity Contract, Single Purchase Payment. Non-participating. GAIA-90 o GENERAL PROVISIONS Definitions We define here some of the words and phrases used in this contract. We, Our, and US.-Prudential. You and Your.- The owner of the contract. Annuitant(s).- The person(s) we show as annuitant(s) on the iirst page. Due Date.- The date each annuity payment is due. The Contract This contract, including all its provisions, forms the whole contract. It will take effect on the contract date only if the purchase payment is paid to us by the time you get the contract. Otherwise it will be void. The purchase payment may be paid at our Home Office or to an authorized agent of ours. If we are asked to do so, we will give a signed receipt. If the contract takes effect, the purchase payment will belong to us. Contract Modifications Only a Prudential officer with the rank or title of vice president or above may agree to modify this contract, and then only in writing. Ownership and Control Unless we endorse this contract to say otherwise: (1) the owner of the contract is as stated on the first page; and (2) while the annuitant is living the owner alone is entitled to (a) any contract benefit, and (b) the exercise of any right and privilege granted by the contract or by us. These rights include but are not limited to the right to designate or change the person or entity to whom annuity payments will be made. To make a change, the owner must notify us in writing in a form that meets our needs. The change will take effect as of the date we receive the notice at our Home Oltice. We will not adjust any payment made or change any action taken before we receive the notice. Currency Any money we pay, or which is paid to us, must be in United States currency. Any amount we owe will be payable at our Corporate Office. Assignment We will not be deemed to know of an assignment unless we receive it, or a copy of it, at our Home Office. We are not obliged to see that the assignment is valid or sufficient. Proof of Life or Death Before we make a payment, we have the right to require proof of the life or death of any person whose life or death determines whether or to whom we must make the payment. Misstatement of Age If any annuitant's stated date of birth or sex or both are not correct, we will change the amount of or Sex the annuity payments to that which the purchase payment would have bought for the correct date of birth and sex. Also, we will adjust the amount of any payments we have already made. Here is how we will do it: (1) We will deduct any overpayments, with interest at 5% a year, from any payment(s) due then or later. (2) We will add any underpayments, with interest at 5% a year, to the next payment we make after we receive proof of the correct date of birth or sex. No Surrender You may not surrender the contract for cash or borrow from us on the contract. and No Loan Non-participation This contract is not eligible for dividends. of Contract (GAIA-gO) Page 2 Prudential ~ Financial [2J The Prudential Insurance Company of America o Pruco Life Insurance Company o Proco Life lnsurance Company of New Jersey All are Prudential companies Annuitant: RICHARD B BENDER Joint Annuitant: JANE T BENDER Contract Number: PIA000000828-A PAYMENT SCHEDULE ~.U*NOTICE***** TIllS IS A LEGAL CONTRACT BETWEEN YOU AND PRUDENTIAL READ YOUR CONTRACT CAREFULLY We will make monthly annuity payments under this contract starting on March 15, 2002, of$778.07 each for as long as any of the annuitants is living. Payments end with the last one due before the death of the last to die of the annuitants if such death occurs after all of the payments certain have been paid. Each annuity payment will be made on its due date to the owner. End of Provision This Schedule attached to this contract on the Contract Date. Endorsed or acknowledged for the Company By 1-0.- ~.~ * Secretary On Contract Date: February 19. 2002 ORD 86567-88 ENDORSEMENTS (Only we can endorse this contract.) Annuity Contract. Single Purchase Payment. Non-participating. GAIA-gO Page 4 ENDORSEMENTS (Only we can endorse this contract.) ALTERATION OF TEXT The provision of this contract entitled "Assignment" is replaced at issue by the following: Assignment We will not be deemed to know of an assignment unless we receive it, or a copy of it, at our Home Office. We are not obliged to see that an assignment is valid or sufficient. This contract may not be assigned to any employee benetit plan or program without our consent. The Prudential Insurance Company of America, By .l~ . - - ~.~ * 88(:re181\' ORD 89323-95 Prudential ~ Finan - . - The Prudentiallnsurf )mpany of America Pruco Life Insurance c,umpany' . A Subsidiary of The Prudential Insurance Company of America ENDORSEMENT Individual Annuity Contract Used to Fund a Non-Qualified Individual Retirement Annuity Program Generally under section 72(s) of the Internal Revenue Code of 1986 (as amended), amounts payable under annuity contracts are required to be distributed on the death of the owner of an annuity contract. Where there is more than one owner, these rules apply upon the death of the first owner. Unless, these rules apply, the contract will not be treated as an annuity contract, payments under the contract will cease to be tax-deferred and penalties may apply. The Limitations Provision ("the Provision") describes the distribution requirements on the death of the owner of this annuity contract. The Provision also describes the special distribution rules if the owner of this contract is a non-individual, such as a corporation. The Provision will not apply on the death of the annuitant unless the annuitant is also the owner of this contract. However, depending on the contract, the contract may end on the death of the annuitant. In the event of the contract owner's death, the Provision overrides other provisions in this contract relating to distributions under the contract. I. DISTRIBUTION REQUIREMENTS - (A) 11 the owner of this contract dies on or after the date the payments under the contract have begun but have not yet been completed, then distributions of the remaining amounts payable under the contract must be made at least as rapidly as the rate that WR!; hBing IJsed at the date of death. (B) If the owner of this contract dies before the date that payments under the contract are due to begin, then distributions of all amounts payable under the contract must be completed within five years alter the owner's death. II. EXCEPTIONS TO THE DISTRIBUTION REQUIREMENTS- The required distributions need not be made in the manner described under the "Distribution Requirements" section above, where any of the following situations apply: (A) Designated Beneficiary: The individual who becomes the new owner or holder of this contract can extend the distributions beyond the above prescribed time limit by choosing to receive distributions that start within one year after the owner's death and extend for a period that does not exceed his or her life or life expectancy. Thus, the beneficiary may choose to receive distributions under a fixed period payout option (for a period not greater than his life expectancy) or a life annuity option. (B) Spouse as Beneficiary: If the individual who becomes the new owner or holder of this contract is the deceased owner's spouse, then the required distributions described in the Provision do not apply until the spouse's death. L-NQ-4-94 L-NO-4-94 III. S ,L DISTRIBUTION RULES WHERE 0' , IS A NON-INDIVIDUAL '- If the owner of this contract is a corporation or other non-individual, the required distribution rules will apply when the primary annuitant dies or is changed. A primary annuitant is the individual whose life affects the timing or payout under the contract. This provision is intended to satisfy the distribution-at-death requirements of Code section 72(s). We reserve the right to amend this contract and endorsement by subsequent endorsement as necessary to comply with applicable tax requirements, if any, which are subject to change from time to time. Such additional endorsement, if necessary to comply with amended tax requirements, will be mailed to you and become eflective within 30 days 01 mailing unless you notify us in wriling, within that time frame, that you reject the endorsement. Signed for the Company, 8\/ _t~-~ ~.'?...Q * 88cre1;OJr:v' r:J ~ olQ. B lr\ 1:'""'" 0 ~ ~ VI ,""t , '-'~.1 -n ";1 - .-\ ~ lrt r"-1?~ '. () ~ ;-. - t.") () "'0 c ,)'-.~ 1 C>,;) ~ ',I C'> U\ r ;~) ;"\\ ~ ~ ::~\ ~ .' ~". .~ L;' ::::::. -J:- SHERIFF'S RETURN - REGULAR CASE NO: 2005-04479 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HATCH CRAIG A ET AL VS PRUDENTIAL FINANCIAL INC RICHARD SMITH Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon PRUDENTIAL FINANCIAL INC the DEFENDANT , at 1520:00 HOURS, on the 9th day of September, 2005 at 150 CORPORATE CENTER DR SUITE 105 CAMP HILL, PA 17011 by handing to BONNIE BROWN, OPERATIONS SPECIALIST, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Postage Surcharge So Answers: 18.00 12.00 .37 10.00 .00 40.37 ,"// ~ ?,'......~:;t':,.C>-?1".,..;r.f ._:e:~ , , R. Thomas Kline 09/13/2005 GATES HALBRUNER Sworn and Subscribed to before By: me this )3 day of eputy Sheriff A.D. WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP BY: Jonathan Dryer, Esquire Attorneys for Defendant Helen e. Lee, Esquire Identification Nos.: 34496/79761 The Curtis Center. Suite 1130 East Independence Square West Philadelphia, P A 19106 (215) 627-6900 CRAIG A. HATCH, EXECUTOR OF the EST A TE OF JANE T. BENDER and the ESTATE OF RICHARD B. BENDER COURT OF COMMON PLEAS CUMBERLAND COUNTY v. CIVIL TERM NO. 05-4479 PRUDENTIAL FINANCIAL, INe. a foreign business corporation, d/b/a THE PRUDENTIAL INSURANCE COMPANY OF AMERICA ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter our appearances on behalf of Defendant, Prudential Financial, Inc. in the above-referenced matter. Respectfully submitted, WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP .~ e}u-- Helen C. Lee, Esquire Attorney LD. No. 79761 Independence Square West The Curtis Center, Suite 1130 East Philadelphia, P A 19106-3308 (215) 627-6900 Attorneys for Defendant Prudential Financial, Inc. 161172.1 WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP'. THE CURTIS CENTER - SUITE 1130 EAST -INDEPENDENCE SQUARE WEST - PHlU\DE\.PHIA, PA 19106 PHONE: (215) 627-6900 ~ FAX; (2.15) 627-2665 WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP BY: Jonathan Dryer, Esquire Attorneys for Defendant Helen e. Lee, Esquire Identification Nos.: 34496/79761 The Curtis Center. Suite 1130 East Independence Square West Philadelphia, P A 19106 (215) 627-6900 CRAIG A. HATCH, EXECUTOR OF the ESTATE OF JANE T. BENDER and the ESTATE OF RICHARD B. BENDER COURT OF COMMON PLEAS CUMBERLAND COUNTY v. CIVIL TERM NO. 05-4479 PRUDENTIAL FINANCIAL, INC. a foreign business corporation, d/b/a THE PRUDENTIAL INSURANCE COMPANY OF AMERICA CERTIFICATE OF SERVICE I, Helen C. Lee; Esquire, hereby certify that a true and correct copy of the Entry of Appearance on behalf of Defendant Prudential Financial, Inc. was served on the following by first-class mail, postage prepaid, this 30th day of September 2005 to: Gates, Halbruner & Hatch, P.c. Byron L. McMasters, Esquire Albert N. Peterlin, Esquire 1013 Mumma Road, Suite 100 Lemoyne, PA 17043-1144 Attorneys for Plaintiff }1{~ ~ Helen C. Lee, Esquire Independence Square West The Curtis Center, Suite 1130 East Philadelphia, PA 19106-3308 (215) 627-6900 Attorney for Defendant Prudential Financial, Inc. 161172.1 WILSON, ELSER, MOSKOWIlZ, EDELMAN & DICKER LLP' THE CURTIS CENTER - SUITE 1130 EAST -INDEPENDENCE SQUARE WEST - PHIlADElPHIA. PA 19106 PHONE: (215) 627-6900 - FAX; (215) 627-2665 Q "C. ,..., = C":;:) c,n CJ n --, \ .r-- , ,. ~.1 G -< co .t o -\ ..., X-n rl1E:. '" c:.) :.'~" '. c; [Tj <D WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP BY: Jonathan Dryer, Esquire Attorneys for Defendant Helen C. Lee, Esquire Identification Nos.: 34496/79761 The Curtis Center. Suite 1130 East Independence Square West Philadelphia, PA 19106 (215) 627-6900 CRAIG A. HATCH, EXECUTOR OF the ESTATE OF JANE T. BENDER and the ESTATE OF RICHARD B. BENDER COURT OF COMMON PLEAS CUMBERLAND COUNTY v. CIVIL TERM NO. 05-4479 PRUDENTIAL FINANCIAL, INC. a foreign business corporation, d/b/a THE PRUDENTIAL INSURANCE COMPANY OF AMERICA NOTICE OF REMOVAL TO FEDERAL COURT TO THE PROTHONOTARY: PLEASE TAKE NOTICE that defendant, by its attorneys, Wilson, Elser, Moskowitz, Edelrnan & Dicker LLP, has filed a Notice of Removal in the United States District Court for the Middle District of Pennsylvania. A copy of said Notice of Removal is attached to this Notice, and served herewith. Please take all necessary actions to transfer the file to the Clerk of the United States Court for the Middle District of Pennsylvania. WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP - -161856.\ .......0........ v-'.... ! Dryer, Jonathan From: PAMDEfilingstat@pamd.uscourts.gov Sent: Friday, October 07,20052:53 PM To: pamd_ecCnef@pamd.uscourts.gov Subject: Activity in Case 1 :05-cv-02050-YK Hatch v. PRUDENTIAL FINANCIAL, INC. "Notice of Removal" ***NOTE TO PUBLIC ACCESS USERS*** You may view tht, filed documents once without charge. To avoid later charges, download a copy of each document during this first viewing. U.S. District Court Middle District of Pennsylvania Notice of Electronic Filing The following transaction was received from Jonathan Dryer entered on 10/7/2005 at 2:52 PM EDT and filed on 10/7/2005 Case Name: Hatch v. PRUDENTIAL FINANCIAL, INC. Case Number: I :QS:cy,ZQSO Filer: PRUDENTIAL FINANCIAL, INC. Document Number: 1 Docket Text: NOTICE OF REMOVAL by PRUDENTIAL FINANCIAL, INC. from Cumberland County Court of Common Pleas, case number 05-4479. (Filing fee $ 250 receipt number 333 103479), filed by PRUDENTIAL FINANCIAL, INC.(aaa) The following document(s) are associated with this transaction: Document description:Main Document Original filename:n/a Electronic document Stamp: [STAMP dcecfStamp _ID= I 027698419 [Date= I 0/7/2005] [FiIeNumber=967997 -0] [2e6cabe 13dOc65b62dd264946abdb 15c3e I fUbc6e4bOfU78e988al c02ffcd 1 acal8a e331 dfc92689de0a264428c3538ed24997a4e6de5df68a78fUb83bfl c594]] 1:05-cv-2050 Notice will be electronically mailed to: Jonathan Dryer dryerj@wemed.com, levyd@wemed.com Albert N. Peterlin a.peterlin@gateslawfrrm.com, 1 :OS-cv-20S0 Notice will be delivered by other means to: Byron L. McMasters Gates, Halbruner & Hatch, P.C. 1013 Mumma Road 10/7/2005 Case 1 :05-cv-02050-YK Document 1 Filed 10/07'/2005 UNITED STATES DISTRICT COURT Page 1 of 36 APPENDIX F fOR THE EASTERN DISTRJCT OF PENNSYLVi\NIA ~ DES1GNATION FORM to be used by counsel to indicate the category of the case for the purpose: of assignmelll to appropriate calendar Address of Plaintiff: 21 r.feadow Drive CanlD Hill P,\ POll Address,ofDefendanl: 751 Broad Street. Newark. NJ 07102-3777 Place of Accident. Incident or Transaction 150 Coroorate Center Drive Suite 105 Caml) Hill PA 1701 ( (Use Reverse Side For Additional Space) Does this civil action involve a nongovernmental corporate party with any parent corporation and any publicly held corporatioo owning 10% or more of its stock? (Attach two copies of the Disclosure Statement Fann in accordance with Fed.R.Civ.P. 7.1(a)) Does this case involve multidistrict litigation possibilities? 0 Yes [!J No RELATED CASE, IF ANY: Case Number Judge _ Dat~ Tenniaated Civil cases are detmed related when)le! is answered to any of the following questions: J. Jfthis case reJakd to property included in an earlier numbered suit ending or within one year previously tcnninated action in this tourt'/ D Yes Il!I No 2. Does this case involve the same issue offact or grow out of the same transaction as apri')r suit pending or within one year previously terminated action in this court? 0 Yes (if No 3. Does this case involve the validity or infringement of a patent already in suit or any earliu numbered case pending or within one year previously terminated action in this coW1? a Yes rEl No CIVIL (Place V in ONE CA TEGOR Y ONLY) A. Federal Question Cases: Indemnity Contract, Marine Contract and AI! Other Contracts fELA L a 2. a 3. D 4. a s. a 6. a 7. a 8. a 9. a 10. a ILa Jones Act.Pcrsonallnjury Antitrust Patent Labor~Management Relations Civil Rights Habeas Corpus Securities Act(s) Cases Soeial Security Review Cases All other Federal Question Cases B. Diversity Jurisdiction Cases: I. IaI Insurance Conflad and Other Contracts 2. a Airplane P""'naIlnjwy 3. a Assault. Defamation 4. 0 Marine Pasonal btilUY S. 0 Motor Vehicle Penonal Injury 6. Ii5I 7. 0 8. a 9. D Other p"",naIlnjwy (PI.... specifY) Ptoducls Liobility Producls Liab llIty - Asbestos All other Dlve,,"ly Cases (please specifY) PlalntifT alleges negligence Ind bream ofOdutilry duty lavolvl..: Ihe salc or.. annuily eODtract. (Pi.... specifY) ARBITRATION CERTIFICATION (Check appropriak CakBO')') I, Jonath8n DrYer F.souire counsel ofl't<:ord do hereby certifY: o Pursuant to local Civil Rule 53.2, Section 3(c)(2), that to the best ormy knowledge:: and belief, thc damages n:eovcrablc in this civil action casc exceed Ute sum o{SISO,OOO.OO cxclusive: ofiotcrest and costs; DATE: o Relid' other fhaq moncJary dam1l8cs is soughL October 4. 2005 Jonathan Drver Esquire Atlorne\'-at.Law NOTE: .>\ trial de novo will he 11 trial by jury only if"therc has becn compliancc with F.R.C.P. 38. 34496 Attorney ID # I cenify that, 10 my knowledge.lhe within case is nol related to any case now pending or within onl: year prc"iollslytenninated action in this court except as noted above cr\'. 609 (4/03) DA TE~ October 4. 2005 At(orne~'-a(.Law /61851.1 34496 .4rtornc:y 1D" JS44 (Rev, 3/99) Case 1 :05-cv-02050-YK llwlL"WVE\ silll~ 10/0i'/2005 Page 2 of 3~PPENDlX H The ]S-44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as requ ired by law, except as provided by loca! rules of cour!. TIlis form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORNI,} I. (.) PLAINTIFFS DEFENDANTS CRAIG A HATCH. EXECUTOR OF THE EST A TES OF JANE T PRUDENTIAL FINANCIAL, fNC, d/b/a THE PRUDENTIAL fNSUR.ANcE BENDER AND RICHARD B BENDER COMPANY OF AMERlCA Count)' of Residem ofFirsl Listed Newark {b) Counly of Residence of First Listed Plaintiff York (IN US. PLAINTIFF CASES ONL Y) (EXCEPT IN lJ .S. PLAINTIFF CASES) NOTE INLAND CONDEMNATION CASES. USE rHCLOCATION OF THE LAND INVOLVED, (c) Auome)"s (Finn Name, Address and Telephone Number) A<<omeys (If Known) Byron L. McMaster!>, Esquire Jonatllan Dryer, Esquire Albert N. Peterlin, Esquire Wilson, Elser, Moskowilz, Edelman & Dicker LLP Gales, Halbruner 4/, Hatch. p.e. The Curtis Center. Suite 1130 East, Independence Square West J013MummaRoad,Suite 100 Pbiladelphia. Pennsylvania 19106 Lemoyn~ PA 17043-1 144 (215)627-6900 (717)731-9600 II. BASIS OF JURJSDICfION (PI~ an"X" in One Box Only) III. CITIZENSHIP OF PRINCiJ'AL PARTIES (Place an "X" it! One Box for o I. U.S. Government Plainliff 03. f"'....Q""''''' (For Diwrsity Cases Only) and One Box for DefeDdlnt) (U.s. Govcmrncn1 Not I party) DEF DEF 02. U.S. Government Defendant I!l 4. """;If Citizen of this Statc 1&1, 0 I Incorporateso;PrincipalPlacc 0 4 0 4 (lndiCIIC CitinDship of OfBwinesJ in 'hi! State PartiesinllcmlD) Citizen of Another Stale 0 2 I!l 2 Incorporates omfPrincipal P1a1:e 0 5 I!l , OC BusjDCS$ ill Another Slate Citizen or Subjccl ofa 0, 0 , ForeignNatioQ 0 6 0 6 Forei_ CcNnlrV IV. NATUREOFSUlT (Place an "X" in One Box OnM CONTRACT TORTS FORfEll'URElPENAL TY BANKRUPTCY OTHER STATUTES 0 110 Insurance I'EQSONAL INJURY o 6IO Agriculluro [J 422 Appeal 28 USC o 4005.... [] 120 Marine o 310 Airpl",e o 620 0Iber Food & [J 423 Withdrowal28 Reapportionment [] 130 Miller Act 0315 Airplane Product lJabiJily Drug use 157 o 410 Antitrust [] 140 Negotiable Instrument o 320 Assault, Ubel & Slonder o 625 Drug Rd.tcd o 430 B..... "'d Banking [] 150 R~overy of o 330 Fcdtnllimploym' U.bilijy Seizure of o 450 CnnuncrcclICC Overpayment k. o 340MlVinc Property 21 use Rates/ete. Enforecmcnt of o 345 Marine Product UaI>iJity o 630 Uquor Laws o 460 Ocportation Judgment o 350 Motor Vehicle o 640 Airlioc Regs. o 470 Racketeer Influenced 0 151 Medicare Act o .355 Molor Vehicle Product Uab. o 660 Occupational ",d Corrupt 0 152 Recovery ofDcfaulted o 360 0Iber Personal Injury SatttyIHcalth Organizations Student Loans (Excl. 0362 Personallnjury-Med. o 690 0Iber o 810SdcctivcScrvice VctCJll11S) o 850 Se<:uriticsl 0 153 Recovery of Malpractice o 365 Personallnjwy-Prod. Li.b. Commoditltsl Overpayment of Exchangc Vctel'1ln'sBct)Cfits PERSONALPROPEQTY 0 160 Stockholders' Suits 0370 Other Fraud o 875 Customer Challenge Il!I 0371 Truth in Lending 12 USC 3410 190 Other Contract o 891 Agricultural Acl$ 0 19S Contract Product 1l!I380 0Iber Personal Property o 892 Economic Liability Dam.s< o 385 P_rty D..."8C Product Stabirizadon Act UabjJjtY o 893 En'iiroMlentaJ REAL PROPERTY CIVIL RlGlers PRISONER LABOR PROPERTY RIGHTS M.1lers nTITIONS o 894 Fncrgy AllocwoD Act o 210 LandCDndemm.ion 0441 Voting o lID Mcoloos o 710 Fnir Labor fJ 820 Copyrights o 895 Fmdom of [J 220 Foreclosure o 4421imployment 10 V..... S"'d"ds Act IJ 830 Pau:ot Infurmalion Act o 230 Rent Lc:ase &: Ejc<tment o 443I1ouslng/ - o 720 LaboriMglnt IJ 840 Tradcmad< o 9ooAppeelofF.. "'''''' o 240 Torts In Land AceommodatiDIlS c..p., Relations Determination [] 245 Tort Product UlIbility 0444 Welfare 0'30 Gco.... 0730 LabcrIMgmt JJ 861 HIA (l395l!) o 950 C....titutionlllity o 290 All Other Real PJOputy o 440 0Iber Civil o SlS DWb Reporting &: IJ 162 DIad< Lanl ofS.... Statutes Rights - Disclosure Act (923) o 890 0Iber SlDIUlDl)' DS40 o 740 Rnilway Labor IJ 863 D1WClDIWW Actions Mandamus Act (405(g)) & Other o 790 Other labor IJ 864 ssm Tille XVI o 550 Civil Liligation IJ 865 RSI 1405(,)) Rights 0791 Empl. ReI. Inc. FEDERAL TAX suns D55SPrison Security Act D 870 Taxes (U.S Condi,ion PfainCiffor Defendant IJ 87/IRS-Third party 26 use 7609 /61853./ Case I :05-cv-02050- 'r K DUGUllltlllll Fil..J 10/0l/2005 P"i::l'" 3 ur 36 (PLACE AN "X" IN ONE BOX ONLY) V. ORIGIN Appeal to District 07 Judge from Magistrate Jud"ment VI. CAUSE OF ACTION (Cite the U.s. Civil Statute under which )'ou are filing and \~Tite brief statement of cause. 00 nol cite jurisdictional statutes unless diversity) Oiversi 28 U.S.c. ~ 1332 (a) I ,Cause of Action between citizens of different states, dama es aile ed to be in excess of'urisdiclionallimit VII. REQUESTED IN 0 CHECK IF THIS IS A CLASS ACTION 0 DEMAND S CHECK YES only if demanded in complaint: COMPLAINT, UNDER F,RCP, 23 >$100,000 JURY DEMAND, 0 Yes 0 No lEI 2 Removed from 0 3 Remanded from Slate Court Appellate Court o 4 Reinstated or Reopened TransferTed fWIn Os another district 06 Multidistrict (specify) litigation o I Original Proceeding AMOUNT OOCKETNUMBER VIII. RELATED eASElS) IF ANY (See instructions): JUOOE: DATE ,/(J-'- Ds-' FOR OFFICE USE ONLY RECEIPT # JUDGE MAG. JUDGE - 2 - 161853.1 JS44 Reverse (Rev G~e 1 :05-cv-02050- YK Document 1 Filed 10/0J/2005 Page 4 of 36 INSTRUCTIONS FOR ATTORNEYS CO~lPLETlNG CIVIL COVEll SHEET FORM JS.44 Authority For Civil Cover Sheet The 1544 civil cover sheet and the information contained herein neither replaces nor supplements the filings ,md service of pleading or olher papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United Statl:S in September 1974, is required for the use of the Clark of Court for the purpose of initiating lhe civil docket sheet. Consequently, a civil cover sheet is submitted 10 Ihe Clark of Court fOf each ,i\'il complaint filed. The attorney filing a case should complete the ronn as follows' I. (a) Plaintiffs-Defendant.'!. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abhreviations. If the plaintiff or defendant is an otliciaJ within a government agenc)', identify first the agency and then the official. gi",'ing bOlh name and tille. (b) CountyafResidence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintitTresides at the time offtling. In U.S. plaintifTcases, enter the name ofihe county in which the firsllisted defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the "defendant" is the location oflhe tract of land involved.) (c) Attorneys. Enter the firm name, address. telephone number and attorney of record. Iflhere are several attorneys. list them on an attachment. noting in this section "(see attachment)". n. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires thatjlJrisdietions be shown in pleadings. Place an "X" in one of the boxes. Iftherc is more than one basis of jurisdiction, precedence is given in the order shown below. United States plaintiff. (1) Jurisdiction based on 28 U,S.C. 1345 and 1348. Suite by agencies and officers ofthc United States, are included here. United States defendant. (2) When the plaintiffis suing the United States, its officers or agencies. place an "X" in this box. Federal question. (3) This refers to suils under 28 U.s.C. 1331, where jurisdiction arises under the Constituli'l)J1 ofthc United StateS, an amendment to me Constitution, an act ofCoogress or a treaty of the United States. In cases where the U,S. is apart, the U,S. plaintiffordcfendant code takes precedence, and box I or2 should be marked. Diversity ofcitiztnsbip. (4) This refers to suits under 28 U.S,C. 1332, where parties are citizens of different :i13tes. When Box 4 is checked. the citizenship of the different parties must be checked. (See Section III beloW; federal question actions take precedence over diversity cases,) Ill. Residencc (citizcnsbip) ofPriadpal Parties. This section of the JS-44 is to be completed if diversity of citizenship was indicated above. Mark this section for each principal party. IV. Nann oISuit. Place an "X" in the appropriate box.- Ifchc nature of suit cannot be determincd, be sure the cause of action. in Section IV below. is sufficient to enable the deputy clerk or chc statistical eJcrks in the Administrative Office to determine the nattlf'e of suit. If the cause fits more than one nature ofsuit, select the most definitive. V. OrigiD. Place an "X" in one of the seven boxes. Original Proceedings. (1) Cases which originate in Ihc United States district courts. Removed from State Court. (2) Proceedings initiated in state courts may be removed 10 the district courts under Title 28 U.S.C., Section 1441. When the petition for removal is granted, check this box. Remanded ftom Appellate Court. (3) Check this box for cases remanded 10 the district court for further action. Use the date of remand as the filing date. Reinstated or Reopened. (4) Checlc this box for cases n:instated or reopened in the district court. Use the reopening date as the filing date. Transferred from Another Distr1cL (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict litigation I1anSfers. Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.s.C. Section 1407. When this box is checked, do not check (5) abov~ Appeal to District Judge from Magistrate Judgment (1) Check this box for an appeal from a magistralc Judg.:'s decision. VL Causc or Action. Report the c:ivil statutedin:cdy related to the cause ofadioD and give a briefdeSQ'iption ofthc cause. VlL Rcqucskd In Complaiat. aus Action. P~ an ..X" in this box if you are filing a class action lmc Rule 23. F.R.Cv.P. Demand. In this space enter the dollar amount ("10 thousands of dollars) being demanded or indicate other dcInand such as a preliminary injunction. Jury Demand. Olcck 1he appropriate box to indicate wbether or not a jury is being demanded. VIII. Related Cases. This section of J544 is used to refercncc mated pending c:ases lfany. Ifthere arc related pending cases, insert the dockctnumbeB and the comspondingjudgc names for such cases. Date aad AUorHY Slptature. Date and sign the civil <:over shcct. - 3 - 161853.1 Case 1 :05-cv-02050-YK Document 1 Filed 10/07/2005 Page 5 of 36 APPENDIX I IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA CASE MANAGEMENT TRACK DESIGNATION FORM CRAIG A. HATCH, EXECUTOR OF the ESTATE OF JANE T. BENDER and the ESTATE OF RICHARD B. BENDER CIVIL ACTION v. JURY TRIAL DEMANDED PRUDENTIAL FINANCIAL, INC., a foreign business corporation, d/b/a THE PRUDENTIAL INSURANCE COMPANY OF AMERICA In accordance with the Civil Justice Expense and Delay Reduction Plan of this court, counsel for plaintiff shall complete a case Management Track Designation Form in all civil cases at the time of filing the complaint and serve a copy on all defendants. (See 9 I :03 of the plan set forth on the reverse side of this form.) In the event that a defendant does not agree with the plaintiff's regarding said designation, that defendant shall, with its first appearance, submit to the clerk of court and serve on the plaintiff and all other parties, a case management track designation form specifying the track to which that defendant believes the case should be assigned. SELEcr ONF OF THE FOLLOWING CASE MANAGEMENT TRACKS: (a) Habeas Corpus - Cases brought under 28 U.S.C. 92241l:hrough 92255 ( ) (b) Social Security - Cases requesting review of a decision of the Secretary of Health and Hwnan Services denying plaintiff Social Security Benefits ( ) ( c) Arbitration - Cases required to be designated for arbitration under Local Civil Rule 53.2 ( ) (d) Asbestos - Cases involving claims for personal injury or property damage from exposure to asbestos ( ) (e) Special Management - Cases that do not fall into tracks (a) through (d) that are commonly referred to as complex and that need speci.al or intense management by the court. (See reverse side of this form for a detailed explanation of special management cases.) ( ) (I) Standard ManagemenL- Cases that do not fall into anyone of the other tracks (X) October 4. 2005 Date Jonathan Drver. Esquire Attorney-at-law Defendant Prudential Financial. Inc Attorney for 215.627.6900 Telephone 215.627.2665 Fax Number drveri(aJ,wemed.com E.Mail Address 161852.] Case 1 :05-cv-02050-YK Document 1 Filed 10/07/2005 Page 6 of 36 IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA CRAIG A. HATCH, EXECUTOR OF the ESTATE OF JANE T. BENDER and the ESTATE OF RICHARD B. BENDER CIVIL ACTION v. JURY TRIAL DEMANDED PRUDENTIAL FINANCIAL, INC., a foreign business corporation, d/b/a THE PRUDENTIAL INSURANCE COMPANY OF AMERICA NOTICE OF REMOVAL AND NOW, comes the defendant, Prudential Financial, Inc. ("Prudential"), and for the purpose of removing this case to the United States District Court for the Middle District of Pennsylvania, respectfully avers as follows: 1. This is an action instituted in the Court of Cor[)1llon Pleas of Cumberland County by plaintiff, Craig A. Hatch, as Executor of the Estates of Jane T. Bender and Richard B.. Bender, on or about August 30, 2005. Prudential was served with the complaint on or about September 9, 2005. 2. This notice of removal, filed within 30 days of service of the complaint, is therefore timely pursuantt028 U.S.C. ~1446(b). 3. A true and correct copy of the complaint, which i:! the only pleading served on Prudential to date, is attached hereto as Exhibit "A." 161856,1 Case 1 :05-cv-02050-YK Document 1 Filed 1010'712005 Page 7 of 36 4. According to the complaint, plaintiff is a citizen of Pennsylvania. The complaint seeks damages of "Seventy-Three Thousand Five Hundred Forty Five and 62/100 Dollars ($73,545.62), plus punitive damages, attorneys fees. . . ." See Exhibit "A". 5. Prudential is a New Jersey corporation with its principal place of business at 751 Broad Street, Newark, NJ 07102-3777. 6. This is a suit of a civil nature, involves a controversy between citizens of different states and the amount in controversy exceeds the sum or value of$75,OOO, exclusive of interests and costs. 7. This court therefore has jurisdiction of this case pursuant to 28 U.S.C. g1332 (a)(l) and 28 U.S.C. gl441. 8. Prudential has simultaneously with the filing of this notice given written notice to plaintiff's counsel. 9. Prudential is also filing a copy of the instant Notice of Removal and all attachments thereto with the Prothonotary of the Court of Common Pleas of Cumberland County. WHEREFORE, defendant Prudential Financial, Inc. ~!ys that this suit be removed to this Honorable Court where it shall proceed as if originally commenced herein. Respectfully submitted, WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP 161856.1 Case 1:05-cv-02050-YK Document 1 Filed 1010l/2005 Page 8 of 36 CERTIFICATE OF SERVICE Jonathan Dryer, Esquire, counsel for defendant Prudential FinanciaL Inc., certifies that he served a copy of the foregoing Notice of Removal on counsel of record by depositing a copy of same in a first class United States Post Office Box, with postage prepaid fully, addressed as follows: Gates, Halbruner & Hatch, p.e. Byron L. McMasters, Esquire Albert N. Peterlin, Esquire 1013 Mumma Road, Suite 100 Lemoyne, PA 17043-1144 1618;6.1 '<t- ['j L" <:j 1. 1';1'1'';1 "" ,,' I' I-< . ~ ',,' .' I . ,>.:, ., : ,\'i t :"'; klVlt '''. ",-,hd ,_, I\H,,) <' ,_,\\1 ~- \,r,)', ') b 'J L Sf'? 1<!9 . 05 ll:.' 06 ~ f'R\JIleNT I FL ns OJ '1171&3891'4 ILl 19738ll243Ul f'. il2aB IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CRAIG ^' HATCH, EXECUTOR OF : the ESTATE OF JANE T_ BeNDER and: ttle ESTATE OF RICHARD B. BENDER,; Civil ActIOn-law Plaintiff. No.At: -4~1 Q~;C [~ Y. PRUDENTIAL FINANCIAl.. INC.. a foreign busine58 corporaUon, dIbla THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Defendant. JURY TRIAL DEMANDED N.QTICE You haw beon ailed In court. 1f)'Oll wi$h \0 defend againtt the claims Ntfozlh In tile following pages, you must lake action within twenty (20) days after this oompfelnt . and notICe are eerved. by entering a 'MItten appearance personally or by attoMey and filing in wrttlng \\4th the court your defenses or obIeetion8 to the claims set fOrth agail'l$t you. You are warned 1hallf you fail to do so !tie case may proceed without you an<! a judgment may be entered against you by the court wittlout further notIca for any money cIlllmed In till' c:ornplalrlt or for any o1her claim or relief requested by the plaintl1J. You may lose R'IOrley or pl\lpelty or other rlghta imporblnl to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCe. IF YOU DO NOT HAVE A LAWYER, GO TO OR TEI.EPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOlJT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER. IHIS OFfICE MAY BE ASLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER Ll;GAL SERVICeS TO eUGIBLE PERSONS AT A R!Duceo FEE OR NO FEE. ~m~~d~~B~~a&m 2 LIberI;y Avenue Curtls/e, PennsylVania 11018 Telephone No. 111.248-3166 Telll'" ,.,,", .;\./ n",;l: '\,.I...' . , ,'" '. .-' .. Il'I Tutmonyw~, i r>bl'.a J/Y.O ~ !.'\1 '''''.N I!Id tre ~ stid ~ CIrtiIII. fa. '-- rNs~~*1PF './ 1[,[ 11"11 ,""I~',[i\:,,,I"',I~ .:,\,>.\.'.'.;u :14, ',-l",'~'i )':."f-\,\ ','1',:' "".j, '_;~i' _' g:p Il':I '$ ~G'lr.' FR 1'!;1.l1J:NT1FL II'S OJ 'i'1~'4 1U 1973El!2431e p . 00V<fJ I. PMIII;j 1. Plaintiff. Craig A. Hatch (tha "E)(9CUtOr")" IS an edulllndivldu81l'6Sldlno lit 21 Meadow DriVe, Camp HID, YoJ'l( County, Pennsylvanfa, 17011, and is the Exea.rtor of tho E8Iste 01 RIchard B. Bend6r lInd the estate or Jane T. Bender. 2. Defendant, Prudential Flnanclsl, Inc. III tl New Jersey corporation with Its prillll~ place ofbU81ness 8t751 Broad Str&et. Newark, NJ 0710~-37n. 3. Prudential Financlal, Inc. seUs 118 annulllaa through The Prudentral Insurance Company 01 Amerlc:a. a dMslOn of Prudential Financial. Inc., VIifh Ita prfnclpal place of bUSiness at 751 BI08d street, Newar1c. NJ 07102037n. 4. The Prudentillll~ Company of America utilizes local bl'ancMllJld officsa 11:1 setllts annullles to its cIlents, one or whIch lIS located at 1!!O Corpornte center Dr.. SUit. 105, Camp Hili, Cumberland Oounty, Pennsylvania, 170'1~'759, It JURISDIg'lON AND VJ:NOIii ~. Juriadlclion la proper PUl$U8nt to 42 Pa.C.,SA S 931(a} wheNI the Instant action IswoIve8 iSubstanllal slate qUeetloM. e. Venue III proper purwant 10 42 PB.C.SAIJ 931(0) and Pa.R.C.P. 2179(:11)(1) where Defendanr. reo~ ofllce i$1ocated In Cumberland County. "I. JrO'RODUgnq.I ? Thl$ case eounda in bl'MCl\ orfidudary dUly and neg1igence on the part of Defendant. 8. Faetualtl. this case cenler8 on Defendant's failure to provide PlaIntiff's Decedents. RIchard B. end J.ne T. Sender(lolnlJy, "8tndlll'8"), with pItlper adViCe 3 '\') L-i.. ';j r,II"L'\' 1./1\'\' .) I\.M '~) . r\ '_ ,", \"I ') '= r '^". ''I I'V' '= ''I' : \":,) -,.l;' c , $S' 9S '195 16:\11 F1'l ~1l'i. l~ en 71'nG33'J7'1 TO 1!173OO24310 P .11I!V26 regarding a surtable Investment of their $100.000.00, i.e. ene which had 8 Ill<ellhood of producing Ircome in IlCtOrdance with the ~nders' stated lnvQ~nt objective. 9. ln8leed, Oeferdant adlli$ed the Benders to purchase an annuity that would pay a fbced sum of money for the remainder 01 tllelr lives. which turned out to be lea than three years fsom when payrnentJl began. 10. Notably, at the time Defendant provided fll'l8rda1lKMce to the 8end81ll. Richard Bender was seve~fIve (1~) YlJIIllI of age with proatate cancer, and Jane Sender was S6vemy~lght (78) }'liars of age and suffering from Cir'rho!Is. cancer and E1mphylema. 11. The annuity that Oefel'ldant adll1$\!ld the Benders 10 puRJhIlSCl for S100.000.00 yielded $178.07 per month forthe mt otthe Benders' lives. 12. In order for the Benders to hava slmply l8COuped the $100.000.00 they Invested. at least one of !hem ~uId have had to survive for len (10) YUNl and nine (9) moJ\ttls after Il'Ie paymenb beg:an. 1 S. Said failure of Defendant to pltlvlde prudent In\/ll$lment udvloe WilS WIOlIgfuIln that the Bendel8, due to their advancad ege and failing health. r9Iiecl on Dtfendant'8 ~ and superior knowledge In Choosing 8 SlJllable inve&1ment of their $100,000.00 that V/Ould produce Income. 14. Defendant's condUct was wlUful, outregeous. and &howed a reckless Indllference llJ the rlghfa of the Benders. 4 ,"I' L '.. ') I L ' L '" r IV' """~" <, U,\' ',\I-l!~l' '0';"" '~,",'i\i ):.r,f','\'l\"'r:."~ ,'-'_' ~ '\ , vi 1, ' ,_. 1~':J, 'J J:; ;,_' : -' h, !'EF' 09 'as 16:07 FI< ~l~ INS ClJ 71~4 TO 1~le P.1il!V<E rv. BACKGROUND 15. In or about Febl\l8ry of 2002, upon informatlon and banef, Andrew Grace. a reprasanllltive of Defendant, provided financial advice to Rlchard Bender and Jane Bender regarding thIlln\lestmellt of thelr $100.000.00. 16. To aid Defendant in delennlnIng $Unable InvMtments fQrtl'le Benders, on or about February 15. 2002. RJohan:l Sender completed and signed a 'customer InfOrmatIOn Form" provided by Defendant, whereln he noted that his "Investment Objective" was "Income," and his ~ Tolerance" wall "Conservative." See attached ~lblt "j.." 17. Thereafter, on or abOvt February 15. 2002. R/c:h8Rf Bender, as 'owner,' ttnd Jane 691'l<ler, a$ 'joint OWtler" eompletsd a "Prudentlallocome AnnUity Appllcallon: See atlached ExhIbit 'S: 1S. As a result of the wbmiAlOn of the Pl\ldentlaJ Income Annuity AppliCatIon. ftle Benders received an annuity contract. on or about February HI, 2002.lhe I'l18blrlal tIIrrn$ ofwhlch are that for a plmlhue prI(;e of $100.001),00, the Bend81'S would receive SnS,07 per month from Defendant, starting Marcl115, 2002, and continuing until the death of the second spouse to die. See attslohed E1chJbit "C..- 19. At 1he time the Benders purchaeed 1he BMulty, RIchard Bender. born Oclober 18,1926, W88 age seventy.fIve (71l1. and Jane Bender, born ~rnber23. 1923, was age $&V$r1ly-flIqIrt (78). 5 :-r ,'j i ) L' L' \ \' ,i.J.,IV:::.,\:~"f-\:\, j~!J.,:\;'j~P, _,:"<,'0/',' ')':.~P,\!:V:::\: 'Cj S r [, - 5EP il'3 '05 1GHI"/ FR mmITtl'L lte OJ 717?6J8'J'14 TO 1913Bll:14310 1".13'1/29 20. The Benders began to raceNe monthly Elnnulty payments on March 15, 2002, In the amount of $778.07, and thesa paymentB continued until Jane Bender's death 0I'l JiIl1UlIry 4, 2005. 21. RlQhard Bender had predeceaHd Jane Bender on July 7. 2004. 22. n,. BGnders l'$Celved a total or thirty-four (34) paymelt$ under the annuity contra<<, totaling $26,454.38. V, CAUSES OF AC110~ Count I Breach of FlduclaN DUlY 23. PSl1Ig1'l1Phs 1-22 aNllncorporated hereIn by reference .lIlf $el: forth In full. 24. Defendant colleded personal and confidential Information about 1tie Benderti. including annuallneome, net worth, liquId net WOIth, risk tolerance. and lr1Velitment objective. 25. Upon InfOrmatlon and belief, Defendant was also aware llat 1he Benda,. were elde/fy 41n<1 anlng-Rk;hard Bender with prostate cancer and Jlfle Bender with cInt1osrs, Cllncer and emphysema, 26. By Vlrtua Of Defendant's mpresent8t1ve's po$lllon as a flnanclal acMsor and \he Bend.~' po8ltlons as elderly, snrno flldMduals seeldng InVQtment advice, the Sendsrs 1nV8St8d D level of trust and confidence In Defendant's reprue.JIlsIive such that !hey sought no other IIMlstment adviCe. 27. Due 10 Defendanfs superior posltlon with respect m the Benders. Defandant tlaCl a duty to aet with scrupulous faltnellll and good faith In Ita dealfngs o 'j J. ',~',~! 'L: L i~: r iI" ~M:KI~~G ~~~NJlk l~~ Jc~A~ ~:N, r',; ~J, ) (, SCP I!l9 '0$ 1S'll'1 FR 1'IllJDENT1~ l~ CO '11'?76J89'14 TO 1;meE24310 P.01Y<!8 with the Bl:lnde~ and not to utIllu the postllon to thfl 3endsIi' dQlJ1mant and Dafendant'a advantage. 28. Oefendant breacl1ed this fiduciary duly t,y adVIsing the aende/'ll to purmase an lMulty thIrt had an exlremet)' law probeblRty of fulfilling their in~ objectNe; to WIt. desplte Defendant's knOwfed~ that the Sendens were elderly and In poor heal\tl and the BGndera' Investm&nt objectlve was "Income.' at least Qne of1he BEll1I1fll"1 W\)Ukj have had to suNIv, forum (10) years and nine (9) months (RIchard Bender would have been eighty-siX (88) years of age; Jane Bender. eJghty.elght (88)) alter !he monthlY p&yn'lenlll began on M8~ 15, 2002, jtJ61 to ",cclve a /8tum of ~ prlncip8/ $Um 01 $1DO,OOO.{){J. ~. Furthermore, If tile monthly payment$ had conltnued fQr !h& following period" the growth rate would 9tm have been le$$ than reasonable for an investment objedlve of ~trlCOme" avan with B 'ooneeMlt!ve" risk preferelJC8: a. EleVen (11)yea/'ll; Growth !lite: O,~14 b. 1Welve(12)yeara:Orowthfllte: 1.95% c. Th/Jteel'l(13) )Ura: Growth rate: 3.11% d. Fourteen (14) Y*8rs: Growth tete: 4.05% eo Fifteen (is) yea...: Growth ra~ 4.82 % f. $Jla8Qn (16) years; Growth rate: 5.45% g. Seventeen (17) YBll"'; Growth 18ft; 5,98%. 30, ThuI, Mr. Bender Wlluld have had to su",1\4e until age ninety-two (92) and/or MIS. BetlderWOUld /lall'e had to survive untU age ninlll)<-flve (95) in orner to 7 '~ t i ! 'j L: I', ') :: L 1. '"I ( I,"ji K~tKl~k~ ~~k:~U~~ L~V JC~h"V!~~: \'; \ ) j !i3" 1/19 'as 1611!13 ~ ~It:l. 1H3 OJ ?17i'63m'4 1t) 19'T.'m24310 1". IlS/2B have racelved a rell1tn on Investment consistent with their inv~tment objective of ~income.. 31. Defendant's conQuct was wlllM outl'llgeous, 11M &hawed a reckless Indifference to the rights of the 8&0011'8. Wherefore, PIaIntJtf, Cl'aIg A. Hatch, Exeoutor of the Estate of RIchan;\ B. Bender and 1he E!1lala of JaM T. Bender, demands Judgment against Defendant, Prudential Financial, Inc. d/b/a The Prudentlallnsuranat Company of America, for damages of Seventy. Three Thousand FIve Hundred Forty-FIVe and 621100 Doltars ($73,545.82) plus punitive damage" attom$Yll feea, costs, I~ and such further relief as the Court deem8 Just and proper. Count II Nealloenc. 32. Paragraph$ 1-31 are I/lOorpol1lted herein by referenoo sa if ht forth In full. 33. Ae!he BMdenl' flnanoial advisor, Defendant tmGd a duty to the Benders to provlde ftnandal advice to them In acwnlance with their stated investment objectIVe of "income" and thelt riak pl8femnce of "conservative: 34. Defendant breached this duty by MlUng the Bendlll$ an annuity that WQUld not meet their investment ObJective; to wit:. Defendant advised the S&nder8 to' pun:/'lat8 an annuity 1hat would not ~ result in. return of principal for a perfod of ten (10) ~ and nitlll (9) months lifter payments began, this deapb Defendant'. kno~dge of the Benders' advanoed age and failing health. g C,' r~' < C, (I~, ''), 2 ':: UM )'_" ii', J '-, . A~tR1CAN SKAN01A LAW DEPARr~E \C, S,61) 3 11':, SEP B9 '12l5 161 BEl FR I'f<\.JI9(Tll't.. INS CO ?1~14 lU 1~lil P.IIY2B 35. The Benders suffered damages a$ a result of Defendant's negligence, I.e. laes of money not recouped by the monthly payments and loss of opporrunlty to /T1<lke II n IrtvestmGnt consi$tent wiU'1lheir slatlld objective. sa. Defendant caused the damages .ulfelVd by the Bendera by))lQVldlng poor~8d\llce. 3T. Defendant's conduct was willful. outrallEiOUl. and showed II reck/ess Indifference 10 1he lights of the Benders. Wherefore, Plalntlff, Craig A. Hatcl1, Executor of !he Estate of RIchard B. Bender and the E8ta18 of Jane T. Bender, demands JUdgment against 06feJlclant. PNdentIal FInanCIal, Inc. dlbJa The PrudentlallnSlJlWlCW Company of Amerlea. for. damages of SeWlnty-'ThrM Ttousand Five Hundred Forty-Flve and 62/100 Dolla,., ($13.545.82) plus punlUve damages. attomays fees, 'coati. lllt8r88t. and such further rafter 68 the Court deem$ Just and proper. RElSp9Ctfully submitted. GATES. HAl..SRUNER & HATCH. P.C. By: ~- Bynm . E&qube PAAtfom.y ID No. 92410 Albert N. Peterlin. Esqulnt PAAUDmey 10 No.. 84180 1013 Mumll'loll Road, SUite 100 Lemoytle, PA 11043 (T17) 131..Q600 (Attom8Y8 for PlaIntiff) Date: 5.;le.. 05 9 t r' I j, L 1_', i_', ':, I L' L ': 'r'I'yli \ ,,, "I '" I" '. I.'!l j 1111 ~ ,I I AIV\';~:,I"'vAI\j '~,K~'~L'\~ :...h'i'l )~",'\ j!~\1 )6 1 < , , 5EP il9 '1iJ5 11;: IE FR PR.JI:eIT IlL INS aJ ?1'r/b3:t.:l74 Tn 1973ail243Ul P. 11/28 VERIFICATION I. CflIlg A. H6Itctl, state that 1 have reviewed the foregoing CQrnp/Blnt and verify that the facts contained tt)e(ejn are true and con'ElCt to !he best of my knOWledge, Infonnatlon and belief. I further V&f't>J that these statements made by me are subject 10 lhe J)llnallle$ of 18 Pa.C.S.A. ft 4904 relating to unsworn 1fslsificatlon to authorities. Date: 1r ~/~ A. Iia1dI r for the Estate of Rlehal'd B. Bender Executor fOr tha Estate of Jane T. Bender 'itf' 'u i!':)') li'i:~IVI AM~KILAN ~KANU1A ~AW JtrA\!Vt~! "V:') 1,'-' !E' B9 'as 16:1lB FR P!UlENTIl'L HIS CIJ 717i'5:l139'7~, TO 19'7.3eai!431a p - 12/213 Exhibit A "er \I' \'( \II n' ~ hl'- ~Mt~IC~~ 'iV}""" '- ~- 'MeN! :,':~ L. L --A"'111 '11~4 TO 1':f(~ P.1:Y2El ~lfL l\oS co $? IiIS 'as 1&.93 FR . & .-.alLUU .. l' _ ..anclal Customer InformatJon Form /'nlll"*~e.Il_Ilf","",,, _ Lilt __ Co/IjIcJ.f~... J..., PnloolLrt~..~ M..~~ ~ Thl& foIm mIJl;lba lot.mldW!! yQlI~ ~ I!glhtlcn tellI1Mt III ~ Qb\aln Qn k1!<<ma&n {n~lo delQ(i'rdnIllhe GUi\aI:ilIly oflhla~. ?!efst~t. all ~ ofll'4 bill. ~ ~~~~~.~. SStn1N (llJlpIyIr lcIenl!Icaliln J) 1 \"'7 ;>.a& J/tq I. ~ I : . .. ., .. _. ~ - I MaIIlII Ste\l$ ~ /b. dDeptndtrb U~ ~ U~ ~ lQ..Q EdIx:atxI LMi ~ U~WClllU~ U= ~Uf4~PIimaIy( l ~~ ~n~~~~ ~~~~ U~&W'OI ~oe.:..:;;!::;tcolih-e UOuakl ~Non-OuelfJlll! II=;: Ill"". Ml'llllI HouIIlJoId Nil I.q..kI t ._~........_~--'- ... lr/:OII'lt' ItiooIll&Z Wo/Ihl NI!W<m' k;;;;'..';' l%>1oS24.999 Q9' Ifr U U z:""':::__Ai $25,CiOll . $48'- W U U U lIltri>nof..hOI/aIlI:Ild , i. $!O,O1O . ~~,9l8 W U U U ~tcaltlI 2 $7&.000 - $99. U LI U U ~MltWolllc'12llIlllCld'" .. ~...--' .. 1 $11>>,000 - $t49. U U U U ldlIM.FctlllbfttWlC ,6 $15O,llQ) . ~ U U ~ CiI IIQl\IIbt..b.,...ttd 1 ~.OCO - ~ LI U U U ==..-=:t.. 3 $lIOO.OOO . $7.4e.M U U W U --........ .. $7$).000 . $9S9,il1ll U U U u =':'liw-:: ~ $1.o00.ooo. $2.489'- U W U U fMOO,OOO . $4.... LI U U. U .~~=~=n Z $5.0c0.ooo. ...-- U U U . U CllliOl'~GOlWllIlIItlD q"'--- Clltluudl N/IlOl'lCYIIIldIl \ $fO,oco,ooo. $:K.9fl8" U U U U ...,.,..,....dtpClfllI. _o00.ooo<<_ U LI U U ~.= ,,=~,~\=~-=:'1l6:lenl rpvea LJNo \ II.MYOU~lD~MiI8Clll~pIn ~~~>s..~~Mt LlYN UNo ~~mIlSWe W l!In1IrU). .......~. IleoiGIiI'N:llSo.....~.~.,...,. 0Rl.,.. I~ I>goo,~t -....." . . I ~ ~:;d.t.(. ~t~~.~tl:$lalel. . . . '~" t~' \ r~ 71~'~ TO 197:lE11l2C10 seF' B9 ' i!5 16: re ~ f'!U&IT 11'L 1 i'I5 OJ . _~ V.....aLlmieIlrI ~(pI<luaIld<.mt>e~llfyursOl~ll\.lTjcfh~lllItt;l(lply): 'Tol811lnca NoM J2S_ ~lile!' Ba*- Og(jorm' Future ~ Fur,rl'- Verioblt ~ ~ol8I1ri:G (eheI:k CillO): rnrlw; PrGIer Illh rl&\:anS IctII ~ kl ~ fO(aa:el'lhg JlOl'f\UaJ 1o\\lel'1Wlm5. ~ ilIp)Ua~pcitqlBlID 1O$tt;t ~ Is velY ~ U Modmtely CO!lUrillllve: ~ 10 Illl:e $'.lIN rJtl( k>&etlI ema~ febuns, Rtduc:a4~ Qr;md~ Illkmt(~lf~l , U ldodtrlll'l ~ lti IIWM an ~ IIII\CIUI'IlclllQlkellllk MdvolltiJlll cclo6SaI~b ~blghet I8'uIa U UocktWly A&III'UIIV.: ~ III III1IlIIlIII ~ t.veI3llt 8lIII:llJII\ 01 tiN and WJla6tt~bIs ~ pm;;pII IolBke~ofpollli.wyhlGl* ran~ UAli~WilrcllalUtllllft~~c:f_llI~/IIlQ_al\lglllMlol\WIr.PtnUlnl1 ~/WQI. ~I~ U PNSGl'Iatlon of CapItal: eam: tl ~"'vMseclyour hve8lIlIaI1tllJQUgh I. nPatClllldlllOnllwlh. 01l18ctiv. pIlI/WIICa b'/lciijIng talh 8lldtol'1:MlI~el&rQ (1.9, Jl1QI'IeYmtrblflllldl, ~ muy~WiIII lMch~"'~ ~oIClIlll)'t8torll$!l), 1\~ tprlnllome: W.beamin\ml.\M>,J~ 110~ rlbc.olsaUlor~ ~ sawriIies. ddllIld 111lll U Growth: SG$lta IC IId1IM ~ of ClIjIIIIlMluglIlr<e&imclI ~ B8Ql1'\\Iee. ACICIIlIIc:Ill*;e,l ~..ll UOtftrwlfltd: 1I1Y(lSlrnont~~illlnbm~~lImsof~~AAelAIcQlion ,t.blellI'1tlll Ie &~ be..CO~ ilIlanCIdCl'Flllllible ~ plIllfilIo(Ma7l101tlu\lGttt..... ~ J'Io\Ipaf1\lrlfl/i>Illl~hlblll1lltlittltfOllQt\~ Ul.illll'1llLnl'A~~,pleMli$1lldfYllIIlh~~""'.Illa.}: ~co.t..llPl.~~ U~l'onla U"-Iy URlllIMr{tan): UOIt6. T_Ilvot(~'P.fi"III~~!lr...sIo,...ib.hllif-*1. /. ~bll'lZ"''"'tofa'lIddltlollllllhl)'lllll~p/IIruI&d're: S I' IYttJ ~b'Jl..tddIlOOriI ~1lwIllh111f. UUlt~'_.">9dI'IIhOI\'lItl1lcClOhdlllllltll)oCpIQ/I6"~-~~ Ual:lUqrJil~ W~FIII'dI UAmIiI.y U RcIaw{frum): - W 0Iher: RaIl1llb: ',', 'j . '1 ',1 1 rr'I .. ! - 1 'a ~ ~!'2.;'_ . ~,..~ ~ ~ ent' 91Qna II ~iI Ram A ~ Oltl mal Ell. W41 '.0" ' I .,.' "," IMtN: /I~'L"'I' .'\1\ \Kk"h; 1-<, :-',':()~'" ,"'I','/' 1_ ". ~ v" 1 '. \,' , ' - N<J )61.'1 ': (', Ie. P.l4/2B , 'I1iIlIlII'bIUon II UmIled kI ~ belefUlat b lUdIPI ofll1hCO!Qlct Is~ IrIt "1f;1Ibnl~C111lll kd~"oIbI futnl&IIedard umr-dllllh ~ ,.... ~~'J6l> a~U. X lJ/-a::A _ WlII'll the MldIl'iS bIstd al811 ~AIlL\QdIM IXftUlIIl fII. ClOll\lIIIJ ~ AUttJal<rlllOll MlcWr ~ Wy.~ I ~thattIM Infonmallon ~ on tbIa r_" acc&ft'Il8lD the ~oI trill ~..ndlnceonl_~""ridpllted/llltCll. DiIo 'do-IS-OJ :: It ~ P~hfl .-ab_ ~ ':L" rJ' L' :",) 1 '2: i'1 .~V:UM \~~ND!A !_611 D:cARHi:\n 5EP rag '1!15 16: ll'3 FR ffiLJDelfT HI... INS ClJ 717/638974 TO 19'7:3S112<l31 e Exhibit B S611; f. 1=j P.I5a13 \, t ~', " U i,1 :': ~ 1 '2 ;cp 89 '1!l5 16' B9 FR I'I\\JDENTI ~ U>IS CO . PrudeII."lal Prv.dcolW Anllllhy $aMtt CenlM PO.t33l1 ~IVA1S'1l1 PIMM ~rInt ""'1111 blllO Or blade In'" ~ :X t.~ J~T fiIIH.nt' 101. ~... (f lll'~ . :J.AnL..__._~__.~...______; OJ (;k~.t!:-l~,_r.'(.'__h'__"'__'" ....--; ~ ~~~~~._.~. _.~...n.~.n~.t..c:..~.<...L_~&,-._~~"""",., ..... ....: ClfI-.J ..... It. tel I In ~ I 1\1""\ \''''''' ) I . I . *T' ~1rl~~~f'!3'--O_~Mi;';';~~I--" ~c;,..u..T~~.J . ~.9J.t.1LIlQYJe~J llL:~~J_!.~.~J; (~2L") ~.s3_J..;. t.$.lJ.._f; 5' 1W\A.,.II~IIIAndn(rdti:r1llal\~ 1 CllGillllhll' . . ,\L II air. ~_J "'" DOwner Infotmllllon 1lIlr .l.lCbl <lWI IIaC::illl!*lJd~ III ...,. AMfkiCAN ANJIA LAW DEfA?'MtNT ;6H ., I ',J ?1 ?'763B'3'i'4 TO 1973E1l1243H!I ~.1EY2a Prudential Income Annuity Application ~~ AllIl~lUSl8t{a) 1.1. tgJ...~~~_r.q..__...n..._-__.j ~ lame l:iTIUItICo~fllllllbbIt) ~A t:.,fOt~Incano~QllI,,* ill IIIe I'nHldaI ilIlmcI ~1 01 Ml&1I:a, 7:11 ~srll8t~, NJ0'11Q2 ~~Ilas'p.~. ~~~TfU$ll 'Io_J ~.~___~..u__.-__~. l.ast~re ~{....n.a.t..( ,_._... h..... ___. _.. _..; , 'r'._-,,_ \.._..l"-NII"""'fI<<lolYtl , , t. _....._... _ ~ ~.J.... _ oJ....... _.I.... ..I._~.."'" ....._..... .._.......1""........ .....1__.._.&_...... ~ ... aI_." _... ....._... ....I__~ _... _.1 Sli'!iet i.3.il-AhJ~L~.L_.s..~_..ct...L..L~_ j~~,:L..s:O_~._. .___b'__-' ...: cay l>Iliiit 2lP CodI ~A.t.t.i..s~.(_q"h~_',.__'_.n: ~P.fl: ~\:,)_,Lt)J_:' ~....__._J $Sf/I'lf ll*1llonlIIolOcII MO.);.J Oalul ~ (n'4, dlr, )'llIl1 AIaa C4ds T~ NmItlw :. D.arqlJ:h1::l3.iJ a.L~.ht~.9Ul!) (t'J.L'l;) :/),..8.8_:. ...$.L?l~ ~.~(llClllcrlll;ntaifl . . ...... ___&..._ .~..._...._.. ..__........-._J MIIll r..- u.s. 0IIzIll R..w.nt ~ AIiGR AlIlIIl Ol.ll1lrJ ~ I , ..J . , '.J , . ....,.- _.....__&.......__1.0_...... _......_...._ .....01 , , ~. _ ._....~__.. _.._.....___~...._..I a.w. Ftfll1lIt u.s. CtizId PMidw ~ )Jan AIiIlI I I 'I L...1 \."J CtI#y . , ..... ,J. _... ........._.... .......... ..16._Ilt........._I..J ~€-a ~~.._...._~_.__.....h..; ~; ~-~.-_.....----...--.-.--.-.-.-...~ ~DDI"o..: L._.. ......." ..4_...".. .. ......"........... ...~..... .....1.. ."'_.._ a...... ...wI_ ........... __ ,,_wl_ ....._. _____ ...._..... _.._I ;:: "OII!,,' ,CIIJ , .-, ;ZJP ca , _ , . ~lia :.........._ ....."...."_..........."...._.....""_..,,......... 11...... L........... ...~...j "'-......_..,... Ei..... SSI(nt(rallb,.....'1Ia.) Cnclil.l1i(Ml,,""r.J1OlIi AmCQS T~..HuIlbtt (t.J.. tit 1 . t ." I I (' ') . f . . J... ...-W" U:s:*'_.r.I.~t--~_~.--~ ~-....-. -..----.. "_..__...1 14 ..,pIy. . l I, ~) ~" ~,. I \....1 \...1 ":1'1 I...J I"._J l,......low~.._...~.._........................__ .',I!.'.,1 -- ..- , . l' 'I" ' : .':, j 1 L "i ~ :''i~ ,~rl;:. k: I !,~ A \;: l A /~\V C!:. r ~ / '-. ^ - ~ I,' - , "/1'/'7638914 10 1~11l P.17/29 5EP i?l'3 'llI5 16' 11l FR PR\..ID€NT[~ US CO AA~Om , I (i1lJ'Tr} '~..,1"."''''.''''~~''...I~~....-.-->-..\''~''."".: SblIlt I;I\edlIilIlll ~ t...~ l..J IS-&IIIY , ' f)tIUftlldlhOl8 \.......-...-...-... ...""............- "'. ...--......._...-.-"'....~.."'-~.. .....~.. _...-...-.......~_.... ...._..-"".-...~._.," .. ,.-..v-- ~~AMiIIt " ." . . SSI1D((Tll1cldel~~ l'Ifm<rJQIM .... . ,I .. , IX' IIIf:DJIt:II "............4._..""............._~......,;.._,.J t....._.J._.........L._.._......; t.:.:J iIt,).... ~llne\lllf.mIdclIlIi6I.I:If/,CII'lIIlmtd1Mt,CoIIlQI..,.,Ofrna, ~.... t ~........... ........... .............""........... .........."'_rIo...... ~... j.. .....~-............._ -"".. ........................ .... J ..' I~ MlbllllillbA/flja!( $WI1N(TGlCldenIIbtionllo.) CI1llOIt ~ &mdIl) S9IfltI ad Olllt elM 0.. o.~" . 'f I It' t , I 1It-c::llflrll \,...._............"'._.....__....._..."'.._..~...J "'....._.._....&...~__I._~_......._.J Io..J \-'OJ 14d&<<t/. FuI ~ ~lIWI_ ~. r.r NImI ofTnlll. Ctapcndon CII' &l1Il1 =ri~ .2 - B Z .. 1 l~fPWI . atltof ItiIun Of SSIllO.2 --=r 3 9 i e _L I 1 , I l...J 1._ J. _~..,,_ ..__...... ~ ._" ..........1._.........._. ... ...J_~.....J . ~ ' L _~...""". _ .._____. ....."". 4......1- ~.._... ........~ .,,1....\0-........... ...---.. .......... .-.j-. ....... ~.........~~.. -...~...-' Cltt StIliI 2lP COde , I I I..' to...... ___.... ............ ..........".._~... ~...._.... _....._.... ....._. !. ~. ...~I t.._.J.......... ",__, \..... ....... - i>- -.) SSIITIl (Tct Ideo>il/dbt fiO.) . 0ilIS 01811\ (an, a:ay, ~.rj AM CedI (~... _"_,I CM1y 7.pIxft Nutnbcr . I I I' I I '.._._.............. ~~ _ ........ _\of..... '" ~.... --'.._... "'...... -... .~......./ ~ FemiIle U.s. 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' ""'...__.._............"" ...._~. . ........._.....~.. __............ ..1_..... t. .....__................-" _ ",_..", ...___...._ J... ..4.....f A4IdcnsIliP b!mllart SSIIllN (fIrll Jdo,~ No,) QIcoee Pltnwy s-4IIy 0111I: CIIIaI CIUo , '--#. .-.. -.........-. -,.....- ... --... ..-...... . . -.. . . ~....._.....___...__..__~_.._J '_J ""'* ~CI\C t):N~ U~lAA t _.: Ct.adW Acct ~~ ~ QuaIIf.c1: t .. llG.'lll ~ 1fClledl'peyabkl \0 ~nlfaI sL...J.. .Q1J...o.~P..: . "'.4) ~i._aW''''''''''llllbw UDhotR*iet UWl() .... n.... ,..".. .. ._... . , .......u.__ . ............ . YI' ._ dooee_ ..J.....- L..---...._ L._'__., 'f""I----' __Q/ACh~ sL......o-.__:1.?21. ;0.,7.: Doltdl'htAlldyl'8yJMnt~ 'O~~lS"'....~JlA_,,* 1llf 1II;t~4IIl1l'llSlbo no"''''' _,..Ibe ~<:t"CIlrdr.ll1kl H'f.1AA.1oI. OIl ml Vi lI\"OlIW"'ht1hl~dU= /lIIanrhal4l_tt<enI1JU'$"'''' ~d" ~ bed m1ynolbt~~.70, ..- " . ~ , :;1; 1: .L' i r',\! AMt.iCAN '~~N)iA LAW DtiA~'Mt~i [('.." )t) 1,1 ~', 1 ~ ?1'r~'llU 1~1i! p , 1 ElI2'a !B' ~ 'ilS t!l:10 Rl ~IFL It-Ei OJ AIlIStUS "... tIuw Ml. Lulllame lrrcat~~ ~...._..... l........~tw....... ._....w~......_-'- _; ~.; ~.... ,...._.......I......~.I_........... -......._~__~. *~. _... ~ ~ SlID,pea. F'.pl~' (If ~bIe) .~ , , ~ l..~.. _..............~.. WoO"__"-. .._.............1.. ....._,,~..... ..._..~....._....... ........ ~..oO.... .._..._..~_... ~.~..._.,,~... ~."I ~ i1 Sl/Il( 1hI'C1ent1 ~..._ _"'.'" ~...... _... ~............. w ..............._..._... .._~.. .oI..~loo ....""........_.~.......... ..._-.10.... ._.. ~ ...1_." _.......: ~ a1y SIlIla ZIP Cede ~.b I "'I '..' I 1<<:iIm"12. 'w~oI.._.....~....J......._..~............~..v__......_j_......~...' I."'._} ....~......................l l...._.....oI....~1 . ~ ttJtnberatRlatl:lllllll5lllu1!oc) , I ~......-,..~..I._~-~......_.~....~.~..---._~-.._....~I ~1Ilt Optl- ::OIW: U~~--__n !MlIItIeI'olDllJlll8l1lsMlh . .~ u. M1<dIJ :.. J UtI Nn!kt~ lfIIlaImInt~ ,. J lJ&AIrdl't'loldl~ llWdct...n.. IU1lbefd~OlllIIih OC'JcltUhISUMowlJlltAMuiy. . /..0.0. 'lilprm.y~L<JJ)_bl!llllll/lllwylllRJbrt ,. J ~lIIld 5lJ'IlvgrUltAllnul1v.i111~ ~ _ ..... "b(lrimlly IMIIIIt .....-'ttlo-*f~ t _J JcIrt lIld SlI\+IQrUlt Am61.pedad'" cC-.... .lUJtlercl plymd WllIR .. u.... fl)pfnrylllllllllat .n_.." tl.......~r nuIInt '~IlI"'Jc:k41ll1l Sriovq:lllontlJ__ n 10C* II 1Ilt___..-.d trme..,...... ..'*'~....~~~tI~pelIl~bOIl...P!tMYIillI,. :.J..... .. MQIllII.... III Pl\IhI1Illidllft J _.da1 lIIIlIIIt IllllUal dIlI_ 'lilt Ptl'~ . _ lIIa.I ~ "__r-*tlt the ~pi/QtIlIlgelDb8 paldla tIf-.x.,lIIIlIilzrillh tmIIY..... ~.w. P..... note: I(l/IldcllooM lllQ%peI4>>tJo~IIIIlIl_)IllII ""YcIlOClIt*'1~,*,lDilIe _..,.,1IIIIAtIIIt J!\'OII d100ta a PI....a;. _iIllrl tOO%~tot'..pdlnaIy nUIri, yalIaultbOola iIlIl:lIIlllc8I pt/Ci_ paid forte SIcmlary ~ :e.~.. 6e'Ii 10 1he ~1I'lII\' 1I'rdIr1l1111 "'" 10 ilIe S8:CIIdIIy ~ ThIll ~ JlIlt*IIaQB wtI be poI4 'Otlll boIIIlhe primIry ard... __1 IIIIIdIIID 1 GIll MlgIllllWlll\> thr....wll1lamWnl U"apedodOll1lln Oplicrllstlldlll....... ~af",* 3 ..~-.t" .y..........~alllp. . . ~. ~'M81.1!I.0jlIbl1s eIecIId.;mtoffltdRofblt otlRdlansilantlllllll bt8UblnillldWIIIlhe ~ _ (ll,g..bHleoll~, ~c,J A \Wlltp~~""lIIIY~iIsrwAI~~~ t.jV.. ~No :: 2 IIoIl If pI, P'O.....llH f6110wirta IntonNsllon fer tad! conllact(a) Met IllOIOM II ~lcllblt ~ PRldtllttlJ' dlsc101U111llnd lIfAto raplKemant formal .~ ;;...._.~_._.;,;..._~_........._.._.: ~~..._..~ .1;1 I t..........-J t....tI__....~............-........_....) $f. ~.. ~';'!~~:..~-:::..~P.....IlII11~1lOlIlI8'1 t_lvos:(.rfNll ~,.,. . , ~. ~~'___.._~"M~_~.~~_._J ~~s. b -- " 2 o ~ .. l .. 1 ..- . j' i'l ':::1 'i: i i: ;..'r'/ AMtK1CA! ~~ANU1A LAW Jt'AK'~tNI S 6 ,; r. 19 7'~4 rn 1~1il P.15v.!B 5EP 09 '1il5 16' 10 FR RUlENTl ft. INS CO . crther pa..... li'183'.iii' iippjk;Siion'i;; i~'~~'~;ce "';" .rl:te~~~~~= :~fn'G;~~ny , !I'\Obl~11y f:lb. lrrlormBlIon or colleR,Ia1or the PUfllOO of mlal6adln~1 InfOrmatlon concerning en)' fac:t material ther;to commltll fralUhllent lnvlll'lUlC8 liCIt, which Is II cMle end subjects lueh p.,.son to crlmlnal and civil pllnalties. W ~ kir an IRA, IhI OImBf8!ll1~eclgB$ *"''Ilno lf1lflA di:sclo~ 5Illt.amlnl1lld l3'ettolilnds 1M! /W ()( st.e will be given , mwiaI dlS1:klStne ~ rillhll ~ The o..ner UIkI~ fl~ "'" deIenIi is ~ by fie lftA. ard~ ~ lie otmels purcl\tiing O1i&WI1~loI'b !1lalIirescmNn l!llI:~efarraj all d~ 1I1111&;tCliuet bI\lclV.lIt, No JVIlIHIlUIt.'tl cmt moI:a9l'~' ~ 01 'IWI\'e ant oIl1le ~y's righIs Irllllllds. ThA 0NntI\11 /Ja&o.u tlU ctfl7ld rri.ela ~ nnds and JIlllIlCW o/JjfloUIa M II ~ f18t b o;ortmlc:I YoiS .~anlhs cIIltft~~lt~.,PndtnIa'..wuib'&IM=CtnlI!r. _rille fII/llIIl8rIIot jcMIllWbI( lIlI4 Ifterllllt IlaIa W bIIoIlI1!IA -v..a IIIsMd. lis ~1hIllhf l)UI1:h8u ~beconIt till abtdlllil ~qft!llcm\plrl'f. 'fq PI1lIllIIIt ~ls IinfIad fll1lle Pll)WqJlbl.~ ~ $td/on 10. an:. )'llI"~lriauod. ~QlI'd ct\qIlilll ~ Qt&n lllal'll>> semtiQd. . ~rWlcorn:thas.JinI ~ dlIalt~llISballollll\llel\ze~lDIIIltClllb ~rS 1IltlIt.. 0MiGrc:t atCAlrllfiollb ~ b ~. <nlttlltCl:ilD%. . Clelts Adrmonall!llmllb . . .ISlgl\lt~cI ~t!lorl:a' tlont 2 o ~ we " 8~ 1 ! . ~ ~ ~ , ,I} ! o ~ -~ _....~--.-_.-~----~----~.--~_..----~_._~--....--....--.~~..~_._----.--.._-----_. .--..--~\:-~;.--_...---r1:-..--..-...--~.__...._--_..--....-.---.._-.-~._-_..__. S9*llll. ~~_~__J:l.:\_.._.... n... __, _..... __ h__ ____.. '. --. . ..n...n...__......_ ~.~ ____.'1:..I!i!~,,""-~~_.. ;;.~......... t. -.:.x1f~~_~_.__. ,tmJIIrIl'a~ (If..!'" ilo<) ~.:"' tom .rt1lXlQl, Dell t/lrtlllY pIISO/I named III Oer<<,,* 0Iner..... ill a' c/laroilG My cum lMm:a Of IIlWAJ lnU1Y (IQn~J(t .Vef, IIRNldt aet8III v:: , ,p"iNo t...:v. "'.1' 11Ie.." ~ In'" beltfllllth putd\BM gfllilllallrlJllll /lPP"i 1..1:lt ~ ~ blladan lhe Wlo.......~ Md.~lliIIlbt~P' r .tit bJiyl1alleM Made IllOlt o..r._"''ll l!ItOMlel'lMldhnd8l~0aed581111l1r..~~ ibe~.. hMbycdM""'....~ RIllIJKiksl~lsn.blha"of ~1).....~_~.....n..____. ==. rCy:.~?:.~.t?; ~~~~~..~-_.~.._--_.._... ~~~..G{4~.Hu..Ifs.~J.._. ~X...._________. '7J.1:?1f:M:Q__ BlIIlOhIF'IlId Cfte n- Brwa:MlilIII \lib Colt TeIopIlclle NIt. ~~J'-.f:lrA.~~.__________. ==-- ~r.J.::z.OJl j; ~-~~___h"'_' ' . . ~'::~~-~-~~_.n n_.......... ._..... n_., ___. ....... h_.... .""'_ __., _0 To. /'rUINnIIaI MIIlIllY SeIVIct r;..u.t 00twn191ll: P'1UlI_I AMuflY llel\>l4a C.nllr PO El0Jl1~ 2101 W.ltIIltbacl PlIlIII<l.rpltlt, PA.1G101 Oreahtr, I'A f!lO:l5 Qu08llonl7 CU.n~ c:aJl(Ua) 17WaaJ (ioU r.....) A;tntol o.oll(8001I14H12.4, flnand.' Advlu~ Cf,A (Sn) MH453 .._ ::-: t ", i Y '- '.' j i 1.' i ,U'M AMtKILAN )KkNUIA 'AN Ut'A11~tN; ','j:' b:)~, SSP '*l '135 16111 FR AUe<r1~ IHS CO 717'163897~1 TO 19'7:lEe2431i1 p . 2iV28 Exhibit C ,r I ~, 1.":,:'~' i: L L riVI AMt~IC~~ ~\A~U:A A~ wtf~~ V~~, C.\ ' )". sa' 09 'lIS 16'11 FR ~1f'L ll-S aJ ,&. . l.Iut~lIUIH e I'IMn' 71 'i'76J897<1 TO 1973Sl24310 I".~ Tn. Prudential Inluranee Company 0' Arnu;c. "lfl'N8rk, N6w Jersey 07102 AnnuIt8..1(.) RICHAFlP B BENOER JANe T BENDER s..~ 0.1e' of Birth M F NovarnDiF 8,19211 NoYemb<or 23, 1923 Co/IlIWIlt Numb<or PIAOOcOOO92&-A ~lNiIy ",ymeot Ollie Man:lI15, 2002 Own.r RICHARD 9 BENDER ~ 0.1e February 19,2002 Pu"'.... P3ynlent $100,000.00 Subject to 1lI11\e ptCIIl$/oM of Ihia QOl1Iracl.1(f8 WID makl all P&1"lI"nta u .laltd In \1'1. payment 1Chedule. UnI40ea WI haw end<>fS8d1he contract III uyOlll.rwlae, we Will make u..p.\'IMf\bIlo!h' 0INnM'. Wo Wwtllo amount tnd due daI6 of eech paymllll iIllht paymenlldllduft. . . n,Je eon\nlOI doos nonlll".' CllI)' VlIIuo. .' ., , PI...... ~1hl. c:onlrect with ,*-, 11 lhel1l 11 llIiwr Ii 9~silon.bOUt~. juat _.. Prvdan1lal:~nl or get II'Ilouch willl 0118 01 0IJl' office:&. . "', ," ,,', . ". " :'::" . '. , RIght to c.w:.l COnIraCL-YOll rTlal' return ihla GQIl!l*l within 10 dAY. afl6\:YW Qittit. All ~u have 10 do Is W<e Ole contraall>r mall it to gll& 0/ our olfk:M or to tile represeiltitlw w/'lq 89ld it to you. h wlII be ~ flOm lI'Ill$1aIt llIlIl .... will ,.t\Jm YOU' money In ~ with &'IaU laW.': "', ' , .""..' .,'." , .' . '. $Igned lor PllldIIndal. ',' ." .' , '. . ~a.: . . ~ ~:a'.:.~.-* .~~:~~~~~ s.c:r~fY .: '. :. " ,I . P191140tIl :. "J". ',' . , ' " ,."... .. ", '. '. ~ Ar1nu~ Conlr8ct. S/1lGI1e PurdlMe paymem. NOn-pa~. <3AIA-110 o l". : Ujll, L (;"'IY AMtKICAN ~KAN~.A l !)l)An!t~1 ~IO ~16 ,:' ~ f c ^ u 5EP ~9 'l!\ U;' 11 FA f'I;!ttNT I "L Ii'C CO 71716389'74 TO 19'730024310 f'. 22/29 GENERAL PROVISIONS DefinitioN We dlIflr'\8 M'~ /lome Qr the wor<!$ll.n<I phrase" used'n thle cOO=. We, Our. and lJa.-PNdarnJ.!. You and Vour,- The owner at the CXllllract. Annultant(a).-ThIl ~on($l we ehow Il4 annultant($) 01\ lh$llrct ptlllO. Que DIIle.- The dale oach B/VIuIIy payment II 'due. The Contract This contract, including all hs prcrvlalon.. fonna ilia wholo con1raOl. It wil\ 11ke lIIlac:l on Ill.. oontrllcl dale only if Ih. purdlaae PI)'lIlanlla paid 10 US blI tha Ume \'ClU gel 11111 ~, O1herwls"ll will be void. The purchaee ~.m may be palel at au. HQcll. 0Ib or 10 an aulhorizl4l1ll8nt 01 OUtll. If we are aeklld 10 do 10. we will give a aigNd fliCeIpt. If the contnlCt bikes e1l",*, IhG purdlase pa~ent will belong 10 UII. Ccntract M04if1Cl1I1""a Only a Prudclnll.\ll ob' with ,he TlllIk 0' lfIle 01 vIca presldent at abava may agcue 10 IlIOdlfy \lIiS conltaol, and III"" ~ In writfng. . , owner.hlp and Cenltol UnI.. we encl._1hIa C4n1l'8ct Il) ~ Olllorwllle: {')1tllI owner ol1he DOntnIl;t Is AS lllaIed on the Ora page; anll (2) whllt Ii'It lMubnlII IMng !he OINIlIO' ~ is entitled \0 (al any canWCt . b_1lI, and (b) 1Ile IOXlIrclat Of Illy ~land pl1Yllege granted by tile _ Of by Ut. The"" ~ Ini;Wt but are IKlt funaed to lhe rfgnlll> deslgnela Or dwJOa the plll8OI1 or Clnlily 10 whollIlInllly paytTlfnl4 wia be mllda. T. make a chane" !he owner ,",,81 noIlIy US k1 wrltina in II lotlll'1ll11 me"", OUl' n..III, nllt chan"" wIllllka eIfect lUl aIlhe dale we rtQJvtIlhe notiCe at our Home 0IIlca. We will not adjust IIlY~ mlll:le or change any K\bI tmbn befQ,.", rec:elve1he no\Ico. Curraney AnJ mQJ\8y we pay. QI' whli;h Ii paid 10 Ut, mllSl be In UNted Sial" CwmICy. Any amount .... owe wit bl plIyQbIe lit our Corpo,.. Office. . Ae~nment W" will not be ~elNd to 1q)ow 01 an aulQl\ll\6IIt unIooa '11I0 r-",e it, or. COllY 01 ft. at our Home OffICe. W. are not obIlgad lll_ thalltlt ~t is -.aid C( llIIftdenl. Proof at Uta Ol' Doelh Sa""" we mille.. ~etIt, wa ha'Ie the rlQh\ \I> require prool 01 \lllJ iii" or dealh of IlII}' pel80n \IIhose Ir. Of d..lIt delennfnea \\toell1er 0I1Al wnolll....l'l\\Jdt rnaJco the ~enl .,lsQItement of Age If anyamullllnt'a slmId daIa of bII1II or lax or bolll art nol cOlTtc:f, .. will cIlllnglt the amOlltlt or 01' Su the IMUity pa)'rMnta to tl\II vdIEh 1ha pu<c:h-. paymel'll would '- bouQhtfarlhe tDI'I'llGt data of blI1lt IIIld sex. 'Also, we wII a4U511he -.noun! oIony PA)IlIenIa we haw alnoedy made. Hate III how we wit clclll: (1) W. wtl<lGdt4 '"Y 1MIll~ -Mlh1nlm8l alS% .~. from "!tI pa)'lTlGf1l(s) ~e1h.al\ C( lale" I2l w. ..U ad4 Ifty uncIetpa)'lllentB, vM1lnt...... 5% . year, 111 the next pIl)lTtenl: WI. mIIIt... "'" recaIVa plllOl of the col!1ll:\ da of biItI'l or sex. No SUrrendar You may nolllUl1'On~r lbe COnllllOt lor ee.eh or boll'OW from 116 01\ II'le ~ .ftd No Loin NQn-plrticipelion 1t1& COl'lll8Cl Is not elJgIblo lor c!lvid&rds. 0' CoI\traCt (GAIA-90) P5!JfJ~ , ~, I ,;, l ,;;' )) i l ; L l r'iVI AIYlt~,'"AI\i c~A1'I~IA LAW JtI',AKllVlt'~' ? 6 i,I~: f'," , ~ g;p 00 '85 16'11 FR ~II'l.. It'S CO 71m:JS9'i'4 TO 19738024310 F' . 23I2l'l Prudential * Financial !llI The Pt\l4letldallnNnllco Comfwly of ~ o l'rw:o Lito ~ CCIDlpaD,)! o Pnlco LiD! lDI:I.nlICll CoI7lplllY at ~ JUlie)' All UI ~tIal eeaTPallies AnlluitAnt: JUCHAliIJ) B BI!NI)EN. Jl)int ADuit8l\ll J'ANE T UNDER COlUrlctNlIll2~r' PlA~... PAYMENT SCBr.DllIJ: ..., .lmtIC:Ba...... nm.AlSOAt.CONnW:fl!lmfEEN YOO AND nIll)EN'IVJ. R]!A1)YCl!lI\ ~CAI!FIll1.Y We will make mcrstbly 1IIIIIlIll:Yp&yznelllS lIlIder dUI ~ J:laJtlIlg IlII MucIl15. 2002. of S7?1.07 eacIl t. II L:ma .. MY alw ........;","'. ilIlivUl& l'Iymrms mil v.iIh 1110 Iaal 0IIll &Ie befura tb:: de8Ib ci1bs lasl to die af1llD >IIIIDiIIIa if SItch alii occun after all af1bt: ~ cataIn hava bccapaid. Each IIlllUity pa)'l1lCllt will ~ made Oa ill due <btc It> 1be 1)1nIa. '.1 &4 ofPmYisiOll ndJ Sclleo!ulAlm-<l>"" to thiI ealtnC:t all tt. Cednlct DlItC. '. .~, lWonod<<.'*r-.!....poI t>r1llA~' 0>>:0 8&S6148 By 1..~. _ ~. ~~ '* ll-*Y . OaCllllmcll)alo.: FclnaIyl',~OO2 : c r, ! 'j, .1 \,,, ') I L ' L L tl'll ~N\tKl~~~ ~~HI~Ulk lk~ utrK'I~tNI ~, i, ': - ., '-.}. } './ '~ ':c: sa> 99 'as 16'12 FR ~1Fl. INS CO 717?6J89'14 m 1~10 P. 24I2fl -- ENDORSEMENTS (Only WQ OWl endo~ lhi$ eonlrac~) (GAlA-FIO) P~3 ":':1 i'j, /"1',',):, IL',L:,]':'i', ~Mt~I~~N )~~NUI~ l~ft Utr~K'MtNI I'<:,~:" '~8 f' , ~ SEP 09 . B:5 16' 12 FR P!UleNT11'L INS m 717/63El914 TO l!l73!1i12431B p,2SaS ENDORSEMENTS (~ \\It ClIIl1 oni:!orst true contrac:t.) Annully C"nlraot. Single PurchlUle Payment. NO~rticipaling. GA~ P6g<>4 "} t I ~ L ':11,: ':. Ii'!..:; rlVI AIVlt!1:\.AI~ ~l\r'HI.i.\ ~~I ~It~!"'" 'IVltl~1 l: I ~ ') I 1.6 !'E' 09 'as 15'12 FR ~lft.. [NS CII 117'16J1i19'74 TO 1~31B P .26128 ENDORSEMENTS (OnlY.... can eMot$e thi.!! CO<1trQ<:l.) AL TERA TlON OF TEXT The p~ of Ihl$ conlTut..mu.d "Aa$lgnmEllil' is raplacad .t iasllt by Iha lolbwtng; AIIIigl'lInellt W. wID !'lot be Cke_d 10 know 01 an uslQtlmtl1l unl.., ... reclliV, ft, or . copy ell iI, III our Heme Ollie<!. w, ITIl net obliged 10 _ !hll an lISOlgnm.nI is valkl or 'uflideol. Th19 CClnlrlel may nol be asGignell to IlftIJ employet bIl.,.rlt plan or flRliram WIthout OUl' _nl. The PnlcIM6a1ln'\Il'ance Company cl AtIlo,rica, Ily ~~ ~ 1l... :-t eOOttlt'l' OAO 8Qa~5 ',' tr 1'/, i '" l..,iJrv: ~m r;. ~ \, /-11\1 ,~, 1\ K IH.: . M U-i VV U [ r H~, VI C I~ I I\ru, ') b :,1 ~ l../ 5EP 09 '05 16' 12 ~ F'RiIEHT1~ INS CO J: " UU~ILUll .. r man 717'/6:'B9?4 TO I9'738iI:1A31'" ~,Z1/iS Tl'Iq Pruoen~1ll 1n!1Jr;< ,mpnny of America prueo Wle IM\lran<:8 wmpllnY- . A Subllcb.ty of ina PN~.n~ In..,rance Company 01 Atneri,.. ENDORSEMENT IndlYldual AnnUIty (::ontracl UsGd ~ Fuld I Na".Oualllllld In<lillldual RmIl8",lM\t Mnuity Program G~ ....der uotlon 72(.) oIlhe ln18ma1 Revenue Co~ of 19M (81 ~n~), IlI'llOUI\Ia paylIbla uncler anouity conlr8l;!5 ara ""'Iuired to be cb\lllulGd en Ill. cIeelh 01 the O'MlIIr 01 an 8MuiIy con1racL Whore tner. ilImctf1 .....n _ o_r, thsse ftJles 8flPl)I upon Ill. llealh cI \he fim owner. Unlesl, ltltse rukla llppIy, lhe conuect v.lIl not be tl'OllIe<I.. M lInlluity =tract. pa~l'IlI under !he conlncl wftl_1O be \a:Il-<lelorred and penalllea may 1IflllIY. The \.imIIaIlons Provialon ("the Provision") de8Ctibe$lhe di8trlbution IllqUIremanlll on \lie cltl1h 011/'1. owner oj IhJs annuity contraol. The PrcMaion elso dMcn'b_lhe ~ dielribuIiDfl rule81t \he tM110r III 'C'Iit contnIC1 ill a nOrHndvUlu~. ....ch 81 I c~. Th. PtoWlIon wlllllOl ap(Jlt on the dedi oI1he annuIllnl.....1ht etlnllilan\ II .1801t>D own" of 1toIe cont/Ilel ~,dependlng on lhe conI18Qt, the ~ may end on !he death of !he antIlJIanl III ..... _nt 01.,. tanlnll:t ownar's dealh, tho fSlIW!aio<l CIIIerIidt. olher praMlonllln thlI conlnlGt NIdr\IJ ID dIstr\Il~ under 1hQ c.at\tl'8Cll. I. DISTRI6UTtON RIlQUtREMSNTS- (A) If Ihe owner of Ihlt ~ dkl. on or.r lhol dI.te 1118 Plym8nlS uader \he COIIlI'lICl hi'" bagur\ but have nClt)llll bMn eomllleltd. Nn ~ oIlhs .......wng arftOlll'lW payable uncI.-IM contl'act muet be made & lout aa r1JIllclly .. ..... ,.,.111., WOOl J:>9li,g UIed aI ~ ~ at death. (8) If Ih. Owtl&r of thle contrII<:l lias before lM date that ~..lIbIljnder the comrt;llll. M 10 begin, Ih8n dlslrbJlIont of "llI'llOl/III1I payabIII undeI' lI\e c;onllaCl rnIMI be completed within lMt ~ aIIltr 1ha ~D deelII. 11. EXC&PTIONS TO Tl-tE DI5ffiIBUT1ON REQUIREMENTS- . . 'ThIIl8qlllred dllllItlr.mon. n,.d IlOI D. mad. in lht mannlll'detcdbed IIlC2r 111. 'tllstrtluII<ln Requlrem.ntS" MCliOn ~ whare any ot1ha IoJo1Mng ~ ~ (A) ~ BeneliCillty. The ~ who *<lmN the NlW OMliWor hok* al ltU GllIllraol can _d ... cIsIriIluIlon. btyOnd the tbovt prwcrlbM t1mtllmJl by "'-alng lD ~ d8trIlutlonelhal: 8Illrt 1MIh1n _ )'tar <<fItl' lIle ownw'a death lIIld exTllnd tor III pedolt thai. 110M nal-=oed lliII or IJCIl' 11ft or . .~, ThII. 1M beMIiciIIy lllII)'''''-tD ~'lI8IrIIudAns UIldIr a ftltld pMcld ~ apdcr) ttor apal\Od not~,...r 111811 hlo 1h ~ \If''' llIe lIMully optictI. (B) Spcus& ~ Bt".nc:iNy. 11111. ~ W/lo btoome:Ilhfl nsw DWIlllr or holder . of 'his CQ(\lract lathe de<:eUlJll owne(e tlpOUM, Ih8n the reqUlr&d dl6ttIluIlons d8$cr1bed In !he PrcMs/on IlO not apply unlilll\& $pO<JU'. clt*lh, L-NQ..._~ tI I';' L' '" L.NQ+9o( li:L'j:IYI ~IYi[~l~HI~ )~hl~UjM ~MW ~trK\I:~ti~, 'oJ, ~ j :', -' 71;>n>.m74 TO 1!nl8il2431ia P. 2EY2l SEP ~ 'EJ5 16: 12 FR PRl.IDENTl~ IHS CO III. S ,L OISTFHSUTION RULES WHERE: 0' , IS A NON-INDlVI DUAL '- " th. owner of thlA ""ntract I, a corporatl6n or oll~r flO/I-lndMdual, lI1a requlnod dlstriblllion rule. wal apply When lh& primary aMuitant cfiol orl. OMngt(!. A primary Il1nUlmnl io tha in<iividunl whose life llifeotS the Umir>;! or PlIyOl1I ' !ndl!lr the contract. This provision ia'i_ded to &oalWy IN dlatrlbut\c.n-al-d6eth Illqulralllanl8 of CoCa "olion 12(a). W. telSllIVe the right to ameod 11\18 eonl{act and endoroQrMnt by fUbM/lu801 al'\dOl'$$m.nl'8 noeeaaary 10 e<lmpl~ wllh .ppIlclQbla tAX ~u1rQfTl8nls, ~ any, whIeh era subject to chango 1Tom time to ~e. Such addlt'lonal ~nl, ij ""l;&$9lry\J) comply with amended l/I.'IC requnm""lI, will ~ mei1ed 10 you III1d ~me eff0c1;"8 w1\l1in 30 dGys 01 Mlllno unllsa 1""1 notlly 118 In wrltlng. v.i1hln thlt limo flame, that you rtjee1 tilt el'tdolumanl. SlgneCllor Ihe Company, Il'( j...- ~~. 6<<:t".... '* "* TOTFL Pl'G:. 26 ... . C2 c_~ ..., C:::J :~}, C::1 (H) -i :') -, o " ..., T-t1 rI1f'-'\ -,~ :.) C.'l \-;'1 ~:~ ~:q ~ ,"':- \.0 Plaintiff I , i I IN THE COURT OF COMMO~ PLEAS CUMBERLAND COUNTY, P~ NSYLVANIA NO. 06-4479 CIVIL TERM SHIRLEY M. KIEHL, v. PHILLIP M. KIEHL, CIVIL ACTION - LAW Defendant IN DIVORCE MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT, made this Z.[ ~ day of December, 2006 b and between , SHIRLEY M. KIEHL, of Mechanicsburg, Pennsylvania (hereinafter "WIFE") and Pti LLlP M. KIEHL, of Carlisle, Pennsylvania (hereinafter "HUSBAND") ; WITNESSETH: WHEREAS, the parties hereto were married on October 23, 1993, in Carl,s e, Cumberland I County, Pennsylvania; and WHEREAS, a divorce action was filed by WIFE on or about August in the Cumberland County Court of Common Pleas, and docketed at 06-4479 Civil Term; WHEREAS, there is one (1) child of the marriage: FELICIA M. KIEHL orn August 3, 1989); and WHEREAS, difficulties have arisen between the parties and it is therefore t ir intention to live separate and apart for the rest of their lives and the parties are desirous of settl ng completely " the economic and other rights and obligations between each other, including but np limited to: the i equitable distribution of the marital property; past, present, and future spousal sf port; alimony, alimony pendente lite, and in general, any and all other claims and possible c1aim~ y one against I the other or against their respective estates; and NOW THEREFORE, in consideration of the covenants and promises hereinla ter to be kept I and performed by each party and for other good and valuable consideration, the p~ ies, intending to be legally bound hereby, the parties do hereby agree as follows: - 1 - , ' 1. ADVICE OF COUNSEL. The provisions of this agreement and their legal effect have been fully xplained to the parties by their respective counsel. WIFE is represented by Mark C. Duffie, E~ uire of Johnson, Duffie, Stewart & Weidner. HUSBAND is currently unrepresented by counsel. Each party acknowledges that he or she has had the opportunity to discuS with counsel of their choosing, the concept of marital property under Pennsylvania law and each i, i aware of his or her right to have the real and/or personal property, estate and assets, earnings ~ d income of the other assessed or evaluated by the courts of this Commonwealth or any other cb rt of competent jurisdiction. The parties further declare that each is executing the Agreement freely and voluntarily having either obtained sufficient knowledge and disclosure of their respective I gal rights and obligations or expressly waiving the right to obtain such knowledge. The parties e13 h acknowledge that this Agreement is fair and equitable and is not the result of any fraud, coercion duress, undue influence or collusion. 2. DIVORCE ACTION. The parties acknowledge that their marriage is irretrievably broken and hat they shall secure a mutual consent no fault divorce pursuant to S 3301 (c) of the Divorce Coq . Concurrently herewith, the parties will sign Affidavits of Consent and Waivers of Notice of Intent to Request Entry of a Divorce Decree, as well as, any other documentation necessary to finali e the divorce immediately. At the expiration of the required ninety (gO) day waiting period from the dI te of effective service of the Divorce Complaint, the parties will sign Affidavits of Consent and WaiVj rs of Notice of ! Intent to request entry of a Divorce Decree, as well as any other documentatiqn necessary to finalize the divorce immediately at that time. This Agreement shall remain in full to ce and effect after such time as a final decree in divorce may be entered with respect to the partie . The parties agree that the terms of this Agreement shall be incorporated into any Divorce Decree hich may be entered with respect to them and specifically referenced in the Divorce Decree. r is Agreement - 2 - shall not merge with the Divorce Decree, but shall continue to have significance. \ indeJ dent \ contractual , ' 3. DATE OF EXECUTION. The "date of execution" or "execution date" of this Agreement shall be d~ ned as the date upon which it is executed by the parties if they have each executed the Agreerr nt on the same I date, Otherwise, the "date of execution" or "execution date" of this Agreement sr II be defined as the date of execution by the last party executing this Agreement. 4. MUTUAL RELEASES. Each party absolutely and unconditionally releases the other and the e~t te of the other from any and all rights and obligations which either may have for past, pr sent, or future I obligations, arising out of the marital relationship or otherwise, including all ri~ s and benefits under the Pennsylvania Divorce Code of 1980, and amendments except as descri~ Each party absolutely and unconditionally releases the other and his or her eirs, executors and estate from any claims arising by virtue of the marital relationship of the pa~i s. The above release shall be effective whether such claims arise by way of widow's or widow~ s rights, family exemption, or under the intestate laws, or the right to take against the spouse's ~il , or the right to treat a life time conveyance by the other as testamentary, or all other rights of a SUi ving spouse to I participate in a deceased spouse's estate, whether arising under the laws of p~ nsylvania, any state, Commonwealth, or territory of the United States or any other country. Except for any cause of action for divorce which either party may have or claim to have, , each party gives to the other by the execution of this Agreement an absolute arj1 unconditional release from all claims whatsoever, in law or in equity which either party now has as nst the other. 5. FINANCIAL DISCLOSURE. The parties represent and warrant that each have made full and fair disclosu e to the other of his or her respective income, assets and liabilities, whether such are held jointly or n the name of I one party alone. Neither party wishes to make or append hereto any further ~ umeration or - 3 - i statement. Each party warrants that he or she is not aware of any marital l identified in this Agreement. The parties confirm that each has relied on th~ financial disclosure of the other as an inducement to the execution of this Agre~ ent. Each party understands that he/she had the right to obtain from the other a complete inv$ tory or list of all property that either or both parties owned at the time of separation or currently a~ that each party I had the right to have all such property valued by means of appraisals or otheryyi e. Both parties ! understand that they have a right to have a Court hold hearing and make deqi ions on matters I covered by this Agreement. Both parties hereby acknowledge that this Agre~ ent is fair and I equitable, the terms adequately provide for his or her interest, and that this Ag$ ment is not the I result of fraud, duress or undue influence exercised by either party upon the othe~ r by any person , or persons upon either party. Each party further covenants and agrees for hims~lf and herself and his or her heirs, executors, administrators or assigns, that he or she will never at, y time hereafter sue the other party or his or her heirs, executors, administrators or assigns in ac~i n of contention, I direct or indirect, and alleged therein that there was a denial of any rights to full ~i closure, or that , there was any fraud, duress, undue influence or that there was a failure to h~ available full, proper and independent representation by legal counsel. 6. SEPARATION-INTERFERENCE. WIFE and HUSBAND may and shall, at all times hereafter, live separate 'f3 d apart. They shall be free from any interference, direct or indirect, by the other in all respects as fully as if they I I were unmarried. Each may, for his or her separate use or benefit, conduct carry q and engage in ! any business, occupation, profession or employment which to him or her may ~ em advisable. I WIFE and HUSBAND shall not harass, disturb or malign each other or the resp, tive families of each other. 7. DEBTS. I The Chase Visa in HUSBAND'S name with an approximate balance of $5; 0.00 shall be I the responsibility and obligation of HUSBAND. HUSBAND shall indemnify ~n save WIFE harmless from any and all claims and demands made against him by reason b such debt or obligation. - 4 - i I I I The Chase Visa in WIFE'S name with an approximate balance of $2,0~ .00 shall be the responsibility and obligation of WIFE. WIFE shall indemnify and save HUSBA~ harmless from , any and all claims and demands made against him by reason of such debt or oblig tion. HUSBAND and WIFE have Wal-Mart, Home Depot and Lowes credit cat s in joint names with an approximate balances of $1,2000, $1,000.00 and $1 ,000.00 respecti~ y. The parties hereby agree to pay that upon the sale of the Residence as provided herein. HUSBAND represents and warrants to WIFE that since the final date of ~ paration he has not and in the future he will not, contract or incur any debt or liability for which WI E or her estate I might be responsible, and he shall indemnify and save WIFE harmless from any ~ d all claims and i demands made against her by reason of such debts or obligations incurred by hi1 ince December 30, 2005. i WIFE represents and warrants to HUSBAND that since the final date of s~ ration she has not and in the future will not, contract or incur any debt or liability for which HUSBA D or his estate might be responsible, and she shall indemnify and save HUSBAND harmless fr m any and all claims and demands made against him by reason of such debts or obligations inculr d by her since December 30, 2005. i \ The parties have no other joint debt other than the mortgage on the maritallr sidence as set forth herein in Paragraph 10. Any debts in either party's name shall be the res~ nsibility of that party regardless of the marital or non-marital nature. 8. RETIREMENT FUNDS. HUSBAND agrees to transfer his Teamsters 401 (k) Plan, with an approxir te balance of $10,000.00 administered by to WIFE pursuant to a QDRO. i he cost of the I QDRO shall be paid from the 401 (k) Plan. Except as previous set forth in this paragraph, the parties hereto expressly wive any right, I title, claim or interest to any retirement fund of the other, except as otherwise ex~r ssly provided I herein. This specifically includes WIFE'S waiver of any right, title, claim or interest' HUSBAND'S Teamsters Pension. - 5 - 9. LIQUID MARITAL ASSETS. , The parties agree that they have no joint bank or credit union account~ nd that existing I joint accounts and individual accounts have been divided to their satisfaction. I Any individual accounts owned by the parties shall become the sole and Is parate property i of the party in whose name the account is currently titled and both parties wait any rights they may have to the bank or credit union account(s) of the other. 10. REAL ESTATE. HUSBAND and WIFE jointly own real property known and numbered ia 27 North Old i Stonehouse Road, Carlisle, Cumberland County, Pennsylvania 17013 !( ereinafter the I IIResidencell~, hich' marital prq~~rty. The parties hereto agree that they shall Iii t the residence ..1- I t- ~IC' 1\1 1'<........ I for sale with. wy. ,". Until closing on the property, H~ BAND shall be I responsible for all past, present and future obligations associated with the! wnership and I occupancy of the residence including but not limited to, the mortgage, taxes, insurr ce and utilities. HUSBAND shall indemnify and hold harmless WIFE for any of these aforement\ ed obligations i attendant to ownership and occupancy of the residence. HUSBAND shall keep th~ Residence free I of any liens or encumbrances other than the existing mortgage with MERS. Duti g HUSBAND's I occupancy and maintenance of the residence, HUSBAND agrees to maintain la d upkeep the i Residence in good condition and to not allow deterioration of the Residence. From the gross proceeds of the sale of the Residence, the parties agree tOI ay off the Wal- Mart, Home Depot and Lowes credit cards as identified herein. At closing on the Residence, the parties agree to divide the net proceeds ~r m the sale of the Residence into equal thirds. WIFE, HUSBAND AND HUSBAND'S Mother shall Ie ch be entitled to one third of the net proceeds. 11. PERSONAL PROPERTY. - 6 - HUSBAND and WIFE agree that WIFE has retained the vast majority f the household goods and that HUSBAND is satisfied that he has received the household good hich he desires. Each party agrees that the present distribution of personal property and househ goods is, under the circumstances, fair and equitable. HUSBAND and WIFE agree that neith r will seek further distribution of the household goods or personal property at either the marit~1 residence or at , HUSBAND'S residence. 12. AUTOMOBILES. A. The 1986 Honda Civic CRX in HUSBAND'S name shall be the ~ Ie and separate property of HUSBAND. HUSBAND shall indemnify and hold WIFE harmless fro', any obligations associated with ownership of the same. B. The 1992 Jeep Cherokee in HUSBAND'S name shall be the sOl and separate property of HUSBAND. HUSBAND shall indemnify and hold WIFE harmless fro~ any obligations associated with ownership of the same. C. The 1991 Ford F-250 in HUSBAND'S name shall be the sole and of HUSBAND. HUSBAND shall indemnify and hold WIFE harmless from associated with ownership of the same. parate property ny obligations D. The 1997 Dodge Avenger in WIFE'S name shall be the sole and Sje arate property of WIFE. WIFE shall indemnify and hold HUSBAND harmless from any obligation~ ssociated with ownership of the same. 13. ALIMONY/SPOUSAL SUPPORT. Both parties are presently employed full time and are capable of ma ntaining such employment. Each party has disclosed their present income and each has had t~e opportunity to ask any questions that they may desire of the other spouse regarding income. Both parties hereby I waive any claims to alimony, spousal support, separate maintenance and alimony Pf dent lite. 14. 2005 TAXES AND PAST TAXES. - 7 - The parties hereto warrant and represent that they have filed II income tax and other tax returns through and including the 2005 tax year. The parties agree at they shall file separate, individual income tax returns for tax year 2006. Each party shall be r ponsible for any income taxes remaining due and payable and shall be entitled to, free of any cl from the other party, any return received. 15. COOPERATION. WIFE and HUSBAND shall mutually cooperate with each other in order tOI terms of the Agreement, including but not limited to the signing of documents. 16. ATTORNEYS' FEES FOR ENFORCEMENT. In the event that there is a dispute regarding the Agreement and either p~ breaches any provisions of this agreement and the other party retains counsel to assist in ent cing the terms i thereof, the breaching party will pay all reasonable attorneys' fees, court cos~s and expenses (including interest and travel costs, if applicable) which are incurred by the other ~ rty in enforcing the Agreement, whether enforcement is ultimately achieved by litigation or by amlc ble resolution. However, the alleged breaching party shall not be required to pay the other partY'$ ttorney's fees, I costs and expenses of the other party in the absence of a written demand to!c re the breach provided to the counsel of record or to the party alleged to be in breach at their las~ nown address. Demand shall be adequate if it is sent via certified mail to the alleged breaching pa~ ' or by regular U. S. mail to counsel of record, and provides at least fourteen (14) calendar day~ r compliance. i For purposes of this provision, and in absence of notice to HUSBAND to th contrary, the presumptive correct address for notice to the WIFE shall be: Shirley M. Kiehl 1280 Hunters Ridge Road Mechanicsburg, PA 17055 For purposes of this provision, and in absence of notice to the WIFE to t~ contrary, the presumptive correct address for notice to the HUSBAND shall be: Phillip M. Kiehl 27 N. Old Stonehouse Road Carlisle, PA 17013 - 8 - . . In absence of a notice to the other party of change of address, a br a breaching party shall not be relieved of obligation for attorney's fees, costs and e paragraph for failure to receive written demand. hing or alleged nses under this It is the specific agreement and intent of the parties that a breaching or i shall bear the obligation of any and all costs, expenses and reasonable counsel i the nonbreaching party in protecting and enforcing his or her rights under this Agr+ rongdoing party ees incurred by ment. 17. WAIVER OF RIGHTS. Both parties hereby waive the following procedural rights: (a) The right to obtain an inventory and the appraisement of ~I marital and non-marital property; (b) The right to obtain an income and expense statement of eith~ party; (c) The right to have all property identified and appraised; (d) The right to discovery as provided by the Pennsylvania Rul~s of Civil Procedure and the Pennsylvania Divorce Code, including but not limited t~, written interrogatories, motions for production of documents, the taking of oral d~p sition, any all other means of discovery permitted under the law; and (e) The right to have the court make all determinations regardin~ marital and non-marital property, equitable distribution, spousal support, alimony ~e dente lite, alimony, counsel fees and costs and expenses. 18. VOID CLAUSES. If any term, condition, clause or provision of this Agreement, shall bel etermined or I , declared to be void or invalid in law or otherwise, then only that term, condition, cla~ e or provision i shall be stricken from this Agreement, and in all other respects this Agreement sh~1 be valid and continue in full force, effect and operation. - 9 - . . 19. APPLICABLE LAW. This Agreement shall be construed under the laws of the Commonwealth ~f ennsylvania. 22. MODIFICATION. 20. ENTIRE AGREEMENT. This Agreement contains the entire understanding of the parties, a~ there are no I representations, warranties, covenants or undertakings other than those expressly! t forth herein. 21. CONTRACT INTERPRETATION. For purposes of contact interpretation and for the purpose of resolving any ~ biguity herein, the parties agree that this Agreement was prepared jointly by the parties. No modification of this Agreement shall be valid or enforceable unless it is written and executed with the same formality as the original Agreement itself. IN WITNESS WHEREOF, the parties hereto have set their hands and seal~ of the day first I I written above. :282995 vA -1hL-- rArf,{.~J hlr{.~1 ~r~ ~o S~6\( liLiGt-I] /V ('Jj W\fE.') t/:JIoJ'~ .(~~) -4,. ~ dJvlrt... So..-,A f~l Jkr..l\ lo~ . . ~) , 1, l..I t L'..-J.I. r,..) ~ ~0 k,.-- 1 S c-'" _ c...A ~ ~d'''L.. 'I, ' 'f"..J fA.> eL J -""!' td -t- elOitPJ / j#".P~ Li....t.\....-..J tl.~~ ~,~- ff1I(,.. 6'l\ ~ I ::1':4 ~. - 10 - < . ,. COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND On the ,z,l'sf' day of 'D€.L.c4-'lIlbe(' , 2006 before me, a N9t ry Public in and for the Commonwealth of Pennsylvania, the undersigned officer, personally apper d SHIRLEY M. KIEHL, known to me (or satisfactorily proven) to be one of the parties execu~i g the foregoing instrument, and he acknowledges the foregoing instrument to be his free act and ~ IN WITNESS WHEREOF, I have hereunto set my hand an notarial seal ~ e day and year first above w'&EMMONWEALTH OF PENNSYlVANIA NOTARIAL SEAL . Cassandra 1. Rosenbaum. Notary Public Lemoyne Boro., CUf!lberland County My Commission Expires Dec. 4, 200~ Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND On the ,;215:1: day Of-f:yfl L/~1Jt.iuv , 2006, before me, a N tary Public in and for the Commonwealth of Pennsylvania, the undersigned officer, personally app ared PHILLIP M. KIEHL, known to me (or satisfactorily proven) to be one of the parties executi~ the foregoing I instrument, and she acknowledges the foregoing instrument to be er free act and d~e . \ IN WITNESS WHEREOF, I have hereunto set my hand an notarial seal t~e day and year first above written. i COMMONWEAlTH OF PENNSYlVANIA Cassandra~OIo~A/AL SEAL Lemoyne 80ro e2~~bm'/Notary Public MMY Commission'ExPire:r 8~~ ~o2uOnty08 ember Pen I . . , , nsy vania Association 01 NOlaIies - 11 - "T"-'- (") ';.'-~ ~ C:;? C::..:;. _.oJ ..,., 1"'-7 C:J 1') GO o -n -I ~F c; ,:) -'..., .. -j- "j ,_../"_r,, :jhi --, .~ ;XJ --< f-') -.l Johnson Duffie, Stewart & Weidner By: Mark C. Duffie, Esquire I.D. No. 75906 301 Market Street P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 mcd@jdsw.com SHIRLEY M. KIEHL, IN THE COURT OF COMMON PLlF S CUMBERLAND COUNTY, PENNSt VANIA , Defendant IN DIVORCE Plaintiff NO. 06-4479 CIVil TERM v. PHilLIP M. KIEHL, CIVil ACTION - LAW AFFIDA VIT OF CONSENT 1. A Complaint in divorce under Section 3301(c) of the Divorce Code was fil~ on or about August 4, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety ~9 ) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree in divorce after service of notice of inte~ti n to request entry of the decree. Date: -12-2 j... l,) " 2..-J )-07 ftw'( 4. I have been advised of the availability of counseling, understand that the C04 list of marriage counselors and that I may request the Court require my spouse and I to'i articipate in , counseling and, being so advised, I do not request the Court require that my spouse and Ii articipate in counseling prior to the divorce becoming final. I verify that the statements made in this Affidavit are true and correct. , underst~n that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904 relating to unsworn f sification to authorities. :287905 (") ~; 1"-,,) = = --.l ""T1 ... co N co .." :z: o -n -i I- mp -r; 1-;-; -y...,r'l, ~ {J '-... ('-~~ ~ ;-) :-;; f~A ~~ ::.0 -< '>: N 0", ----.---.-.---"._"'-- Johnson Duffie, Stewart & Weidner By: Mark C. Duffie, Esquire 1.0. No. 75906 301 Market Street P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 mcd@jdsw.com Plaintiff IN THE COURT OF COMMON PL~ S CUMBERLAND COUNTY, PENNS'( VANIA I I SHIRLEY M. KIEHL, Defendant IN DIVORCE NO. 06-4479 CIVIL TERM v. PHILLIP M. KIEHL, CIVIL ACTION - LAW WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division II f property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is e~t red by the I Court and that a copy of the decree will be sent to me immediately after it is ~I d with the Prothonotary. I verify that the statements made in this Affidavit are true and correct. I un~e stand that I false statements herein are made subject to the penalties of 18 Pa.C.S. S4904 relatin$ 0 unsworn falsification to authorities. Date: l~ 2-~C 2.-/) -0/ tM'J <. :287905 0 r-..:;l 0 = r;;~ C;:::;,l -n --' -r; ::;i ~; -s-n C7) n,p - ' 'I N 0 m 1 () -0 ' ' -'"'~ ('~~), ;;.,< r~-~ N ,J C~.\ 1'':> :'rj en -< -_._------~.------ Johnson Duffie, Stewart & Weidner By: Mark C. Duffie, Esquire I.D. No. 75906 301 Market Street P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 mcd@jdsw.com Plaintiff IN THE COURT OF COMMON PLI)2: S CUMBERLAND COUNTY, PENNSY VANIA NO. 06-4479 CIVIL TERM SHIRLEY M. KIEHL, Defendant IN DIVORCE v. PHILLIP M. KIEHL, CIVIL ACTION - LAW AFFIDA VIT OF CONSENT 1. A Complaint in divorce under Section 3301(c) of the Divorce Code was file on or about August 4, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety ~!9 ) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree in divorce after service of notice of inte~ti n to request entry of the decree. 4. I have been advised of the availability of counseling, understand that the Cou I list of marriage counselors and that I may request the Court require my spouse and I tOI articipate in I counseling and, being so advised, I do not request the Court require that my spouse and 1\ articipate in , counseling prior to the divorce becoming final. Dated:;))1 )Jt - :287905 d/l.3 o7:pt. I verify that the statements made in this Affidavit are true and correct. I underst~n that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904 relating to unsworn fa sification to authorities. (') ~ 0 =...:> -:.;: t,:::::') 11 .-J ..." ~ ...... r'f'-: Fii ., C'.J P r"-n r-..., Ci CO ,_.~~ "'-,"...- -0 .. ~1"1 == C) N ~.~S fll ...-1 '1:>> N :;0 en -< IN THE COURT OF COMMON PL$ S CUMBERLAND COUNTY, PENNSt VANIA NO. 06-4479 CIVIL TERM Johnson Duffie, Stewart & Weidner By: Mark C. Duffie, Esquire 1.0. No. 75906 301 Market Street P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 mcd@jdsw.com SHIRLEY M. KIEHL, Plaintiff v. PHILLIP M. KIEHL, CIVIL ACTION - LAW Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division f property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is erlt red by the , Court and that a copy of the decree will be sent to me immediately after it is f\1 d with the , Prothonotary . I verify that the statements made in this Affidavit are true and correct. I unde stand that I false statements herein are made subject to the penalties of 18 Pa.C.S. 34904 relatinq 0 unsworn falsification to authorities. Date: ;.;; b / /utl5 , , c2!/a!o7 ~~ :287905 I"...:l = c.::> -' o ., ::::1 .L-n nl\_~ ,., y ~'-., <"-'/ c2~ '.J -I -r;.,. <b =< "7l rr1 C:;l N 0:) -'J 1') N C'l PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information to the court for entry of a decree: 1. Ground for divorce: Irretrievable breakdown under 3301 (c) 3301 (d) (1) of the Divorce Code. (Strike out inapplicable section) 2. Date and manner of service of the complaint: August 15, 2006 via ha Acceptance of Service was previously filed with the cou (2) Date of filing and service of the plaintiff's affidavit upon the respon I I delivery. 9/14/06. 3. Complete either paragraph (a) or (b). a. Date of execution of the affidavit of consent required by 3301 (c) of e Divorce code: byplaintiff 2/13/07 ;bydefendant 2/13/07 I b. (1) Date of execution of the affidavit required by 3301 (d) of the Divorc~ I 4. Related claims pending: All claims have been settled Settlement Agreement dated 12/21/06, which shall be int . S. Complete either (a) or (b) i a. Date and manner of service of the notice of intention to file praecipe to transmit record, a copy of which is attached: \ b. Date of plaintiffs Waiver of Notice in 3301 (c) Divorce was file~ ith the Prothonotary: Herewi th I Date defendant's Waiver of Notice ill 3301 (c) divorce was Prothonotary: Herewi th o the Marital ed but not merged ith the 1'-'::> <.-:;:) = ........ -., r~"1 c:.; t".) 0',) o "Tl ~1J n.~ C:'t -i-i -"i"! (-s rn '? ~- r.'Y N -..\ ----