Jackson National Life Insurance Company v. Ifshin

ELECTRONICALLY FILED DOC #: Memorandum Endorsement DATE FILED: 11/10/2020 Jackson National Life Insurance Company v. Ellen A. Ifshin and Gregory T. Bond, 20-cv-06930 (NSR) On August 27, 2020, and then again on September 2, 2020, Plaintiff Jackson National Life Insurance Company (“Jackson National”) filed a motion with the Court requesting an order: (1) directing the Clerk of the Court to permit Jackson National to deposit the annuity proceeds into the Court Registry; (2) enjoining Defendants Ellen A. Ifshin and Gregory T. Bond, and all other parties, from instituting or prosecuting any duplicative action; (3) discharging Jackson National from further liability with respect to the Proceeds and Annuity; (4) dismissing Jackson National from this action, and (5) awarding attorneys’ fees and costs to Jackson National (the “Deposit Motion”). (ECF Nos. 6 & 13.) Jackson National initially failed to comply with this Court’s local rule requiring the submission of a pre-motion conference letter setting forth the basis for its motion. But, on September 18, 2020, filed a letter requesting a pre-motion conference, or, in the alternative, to set a briefing schedule and hearing date for the Deposit Motion. (ECF No. 18.) Finally, Jackson National has informed the Court through electronic mail that, as of November 10, 2020, Defendant Gregory T. Bond has consented to the Deposit Motion, and that it has been unable to reach Defendant Ellen A. Ifshin. Despite Jackson National’s initial failure to comply with this Court’s local rules, the Court waives its requirement for a pre-motion conference, and deems the Deposit Motion fully briefed. Jackson National’s unopposed Deposit Motion (ECF Nos. 6 & 13) is GRANTED in part: (1) Jackson National is permitted to deposit the proceeds for the subject annuity into the Court Registry; (2) Defendants are enjoined from instituting or prosecuting any duplicative action affecting the subject annuity proceeds; (3) Jackson National is dismissed from this action; and (4) Jackson National is discharged from further liability with respect to the subject annuity and proceeds absent a showing of good cause by Defendants as to why they did not timely oppose the Deposit Motion. Further, Jackson National is granted leave to file a separate motion requesting attorneys’ fees and costs with the following briefing schedule: (1) Plaintiff’s moving papers shall be served, not filed, on December 10, 2020; (2) Defendants’ opposition papers shall be served, not filed, on January 11, 2021; and (3) Plaintiff’s reply papers shall be served on January 26, 2021. Plaintiff is directed to file all motion documents, including any opposition, on the reply date, January 26, 2021. The parties shall provide two (2) copies of their respective motion documents to Chambers on the date the documents are served upon their adversary. Plaintiff is directed to serve copies of this Memorandum Endorsement on Defendants and show proof of service on the docket. Jackson National’s motion requesting a pre-motion conference (ECF No. 18) is DENIED as moot. Accordingly, Jackson National is directed to deposit $15,297.56 with the Clerk of the Court. The Clerk of the Court is kindly directed to take in $15,297.56 to be placed in the Court Registry’s interest-bearing account. The Clerk of the Court is further directed to terminate the motions at ECF Nos. 6, 13, and 18. Dated: November 10, 2020 SO ORDERED: White Plains, New York HON. JUDGE NELSON S. ROMAN U.S. DISTRICT COURT JUDGE, S.D.N.Y. POLSINELLI PC Frank T. Spano Darnell Stanislaus 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 fspano@polsinelli.com dstanislaus@polsinelli.com Attorneys for Plaintiff UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK JACKSON NATIONAL LIFE INSURANCE COMPANY, Case No. Plaintiff NOTICE OF MOTION v. ELLEN A. IFSHIN f/k/a ELLEN, A. BOND and GREGORY T. BOND, Defendant PLEASE TAKE NOTICE that upon the Declaration of Theresa Thompson, the Interpleader Complaint and the exhibits attached thereto, and the accompanying Memorandum of Law, Plaintiff Jackson National Life Insurance Company (“Jackson National”) will move this Court, at the United States Courthouse for the Southern District of New York, located at 300 Quarropas Street, White Plains, New York, at a date and time to be designated by the Court, for an order granting Jackson National leave to deposit into the Court’s registry the death benefit owed under an annuity issued to Focus 2000 for Annuitant Philip G. Bond, and: (a) discharging Jackson National from further liability under the annuity; (b) enjoining the competing claimants from initiating any separate action against Jackson National and/or its agents with respect to the Annuity; (c) awarding Jackson National its reasonable attorney’s fees and costs; and (d) dismissing Jackson National from this action. Dated: New York, New York August 26, 2020 POLSINELLI PC By: /s/ Frank T. Spano 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 Fax No. (212) 684-0197 fspano@polsinelli.com dstanislaus@polsinelli.com ATTORNEYS FOR PLAINTIFF POLSINELLI PC Frank T. Spano Darnell Stanislaus 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 fspano@polsinelli.com dstanislaus@polsinelli.com Attorneys for Plaintiff UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK JACKSON NATIONAL LIFE INSURANCE COMPANY, Case No. Plaintiff v. ELLEN A. IFSHIN f/k/a ELLEN, A. BOND and GREGORY T. BOND, Defendant MEMORANDUM OF LAW IN SUPPORT OF PLAINTIFF’S MOTION TO DEPOSIT POLICY BENEFIT INTO THE COURT’S REGISTRY AND FOR INTERPLEADER RELIEF Plaintiff Jackson National Life Insurance Company (“Jackson National”) respectfully submits this memorandum of law in support of its Motion to Deposit Policy Benefit into the Court’s Registry and for Interpleader Relief. I. FACTUAL BACKGROUND 1. On January 3, 1989, Jackson National issued a Flexible Premium Deferred Annuity Policy, bearing Policy Number 0004865310 (the “Annuity”) to Focus 2000 with Philip G. Bond, deceased being the annuitant (“Annuitant”). See Declaration of Theresa Thompson at ¶ 3. 2. The proceeds of the Annuity are subject to competing claims as the result of the death of Annuitant. See id. at ¶ 4. 3. On or around February 21, 2020, Jackson National was provided, among other things, a certificate of death of Annuitant, who died on July 1, 2016, as a resident of San Diego, California. See id. at ¶ 5. 4. As of August 12, 2020, the value of the Annuity’s death benefit proceeds is $15,297.56 (the “Proceeds”). See id. at ¶ 6. 5. The Annuity identifies the primary beneficiary as Ellen A. Ifshin f/k/a Ellen A. Bond (“Ifshin”), Annuitant’s ex-wife and the contingent beneficiary as Gregory T. Bond (“Bond”), Annuitant’s son. See id. at ¶ 7. 6. On February 21, 2020, Bond provided to Jackson National an executed claim form, along with a Marital Settlement Agreement between Annuitant and Ifsin. See id. at ¶ 8. 7. On March 14, 2020, Jackson National sent correspondence to Bond informing him that Ifshin was the designated beneficiary of the Annuity. See id. at ¶ 9. 8. On May 4, 2020, Jackson National sent correspondence to Ifshin advising her that she was the named beneficiary under the Annuity and asking her to return an executed claim form if she intended to claim the proceeds of the Annuity by June 1, 2020. See id. at ¶ 10. 9. On May 4, 2020, Jackson National notified Bond that Annuitant’s divorce from Ifshin did not automatically revoke her designation as the beneficiary of the Annuity and asked Bond to notify Jackson National if he disagreed. See id. at ¶ 11. 10. On May 16, 2020, Jackson National received Ifshin’s Election Regarding Claim Proceeds in which she claimed she was the proper beneficiary of the Annuity and intended to file a claim for the Annuity’s death benefit proceeds. See id. at ¶ 12. 11. On May 12, 2020, Bond sent a letter to Jackson National, stating that if Ifshin attempted to claim the Proceeds he would contest her claim. See id. at ¶ 13. 12. On June 1, 2020, Jackson National received from Ifshin an Annuity Death Benefit Claim Form indicating that she elected to claim the Proceeds. See id. at ¶ 14 13. Jackson National is unable to determine the validity of the conflicting and competing claims to the Proceeds of the Annuity and fears that payment of the Proceeds to any one claimant will subject it to additional liability to the other claimants seeking payment of the Proceeds under the Annuity. 14. Jackson National has no interest in the Proceeds except to the extent such payment discharges any and all obligations Jackson National may owe to any party arising out of the Annuitant’s death and the benefit payable as a consequence thereof under the Annuity. 15. On this same day, Jackson National filed this statutory interpleader action pursuant to 28 U.S.C. § 1335 as a disinterested stakeholder claiming no interest in the Proceeds of the Annuity. II. LEGAL ARGUMENT A. Jackson National is Entitled to an Order to Permit Deposit of the Proceeds into the Registry of this Court. This Court has held that in order to exercise jurisdiction over a statutory interpleader action under 28 U.S.C. § 1335 , the interpleader plaintiff must deposit the money or property at issue into the registry of this Court. See, e.g. Fed. Ins. Co. v. Tyco Int’l, Ltd., 422 F.Supp.2d 357 (S.D.N.Y. 2006). Pursuant Fed.R.Civ.P. 67(a), Jackson National requires an order from this Court to direct the Clerk to permitting deposit on the Proceeds. Accordingly, Jackson National respectfully requests and order from this Court allowing Jackson National to deposit the Proceeds into the Court’s registry, and, thereafter, to be discharged from further liability with respect to the Proceeds and the Annuity and to be dismissed from this action. B. Jackson National is Entitled to an Injunction Against Duplicitous Actions 28 U.S.C. § 2361 provides that In any civil action of interpleader or in the nature of interpleader under section 1335 of this title, a district court may issue its process for all claimants and enter its order restraining them from instituting or prosecuting any proceeding in any State or United States court affecting the property, instrument or obligation involved in the interpleader action until further order of the court. This Court has determined that an “injunction against overlapping lawsuits is desirable to insure the effective of the interpleader remedy. It prevents the multiplicity of actions and reduces the possibility of inconsistent determinations.” Sotheby’s Inc. v. Garcia, 802 F.Supp. 1058 (S.D.N.Y. 1992) Accordingly, Jackson National further requests that the Court enter an Order restraining Defendants, their heirs, legal representatives, successors and assigns, and all other persons claiming by, through, or under them, be permanently enjoined and restrained from instituting or prosecuting any action in any state or United States Court against Jackson National and its agents and representatives with respect to the Annuity or the Proceeds. C. Jackson National is Entitled to an Order of Dismissal Upon Jackson National’s deposit of the Proceeds into the registry of the Court, Jackson National respectfully requests an order of discharge from further liability with respect to the Annuity and the Proceeds and an order of dismissal from this action. D. Jackson National Requests its Attorneys’ Fees Finally, Jackson National requests an order awarding Jackson National its attorneys’ fees and costs to be paid from the Proceeds. Jackson National is a disinterested party that was forced to bring the present suit after competing claims by the ex-wife and son of the Annuitant. Dated: New York, New York August 26, 2020 POLSINELLI PC By: /s/ Frank T. Spano 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 Fax No. (212) 684-0197 fspano@polsinelli.com dstanislaus@polsinelli.com ATTORNEYS FOR PLAINTIFF POLSINELLI PC Frank T. Spano Darnell Stanislaus 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 fspano@polsinelli.com dstanislaus@polsinelli.com Attorneys for Plaintiff UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK JACKSON NATIONAL LIFE INSURANCE COMPANY, Case No. Plaintiff v. ELLEN A. IFSHIN f/k/a ELLEN, A. BOND and GREGORY T. BOND, Defendant DECLARATION OF THERESA THOMPSON IN SUPPORT OF MOTION TO DEPOSIT Theresa Thompson, pursuant to 28 U.S.C. §1746 , and under penalties of perjury, hereby affirms and states as follows: 1. I am a Claims Examiner at Jackson National Life Insurance Company (“Jackson National”), the plaintiff in this action. The information contained herein is either personally known to me or has been obtained from (1) people whom I believe to be reliable and capable of ascertaining the facts described herein or (2) records maintained by Jackson National. 2. I submit this declaration in support of Jackson National’s motion for an order permitting the deposit of the proceeds of Jackson National Flexible Premium Deferred Annuity Policy, bearing Policy Number 0004865310 (the “Annuity”) into the Registry of this Court. 3. The Annuity was issued on January 3, 1989 to Focus 2000 with Philip G. Bond, being the annuitant (“Annuitant”). See Annuity, attached as Exhibit 1. 4. The proceeds of the Annuity are subject to competing claims as the result of the death of Annuitant. 5. On or around February 21, 2020, Jackson National was provided, among other things, a certificate of death of Annuitant, who died on July 1, 2016, as a resident of San Diego, California. See February 21, 2020 Fax to Jackson National, attached as Exhibit 2. 6. As of August 12, 2020, the value of the Annuity’s death benefit proceeds is $15,297.56 (the “Proceeds”). 7. The Annuity identifies the primary beneficiary as Ellen A. Ifshin f/k/a Ellen A. Bond (“Ifshin”), Annuitant’s ex-wife and the contingent beneficiary as Gregory T. Bond (“Bond”), Annuitant’s son. See Annuity, attached as Exhibit 1. 8. On February 21, 2020, Bond provided to Jackson National an executed claim form, along with a Marital Settlement Agreement between Annuitant and Ifsin. See February 1, 2020 Fax from Bond to Jackson National, attached as Exhibit 2. 9. On March 14, 2020, Jackson National sent correspondence to Bond informing him that Ifshin was the designated beneficiary of the Annuity. See March 14, 2020 Letter to Bond, attached as Exhibit 3. 10. On May 4, 2020, Jackson National sent correspondence to Ifshin advising her that she was the named beneficiary under the Annuity and asking her to return an executed claim form if she intended to claim the proceeds of the Annuity by June 1, 2020. See May 4, 2020 Letter from Jackson National to Ifshin, attached as Exhibit 4. 11. On May 4, 2020, Jackson National notified Bond that Annuitant’s divorce from Ifshin did not automatically revoke her designation as the beneficiary of the Annuity and asked Bond to notify Jackson National if he disagreed. See May 4, 2020 Letter from Jackson National to Bond, attached as Exhibit 5. 12. On May 16, 2020, Jackson National received Ifshin’s Election Regarding Claim Proceeds in which she claimed she was the proper beneficiary of the Annuity and intended to file a claim for the Annuity’s death benefit proceeds. See May 16, 2020 Election Regarding Claim for Proceeds, attached as Exhibit 6. 13. On May 12, 2020, Bond sent a letter to Jackson National, stating that if Ifshin attempted to claim the Proceeds he would contest her claim. See May 12, 2020 Letter from Bond to Jackson National, attached as Exhibit 7. 14. On June 1, 2020, Jackson National received from Ifshin an Annuity Death Benefit Claim Form indicating that she elected to claim the Proceeds. See Ifshin Annuity Death Benefit Form, attached as Exhibit 8. I declare under penalty of perjury that the foregoing is true and correct. DATED: August 21, 2020 DocuSigned by: [ tune Thompson. . 66459ACED2E7445... LUCLesd LUOUIPSOU 744858172 JACKSON NATIONAL LIFE INSURANCE COMPANY 1 Corporate Way Lansing, Michigan 48951 A Stock Company Will pay the benefits provided in this policy, subject to its terms and conditions ® POLICY NUMBER 0004865310 POLICY DATE JANUARY 3, 1989 THE ANNUITANT PHILIP G BOND AGE 50 MALE THE OWNER FOCUS 2000 PLAN FLEXIBLE PREMIUM DEFERRED . ISSUEDATE JANUARY 3, 1989 ANNUITY ANTICIPATED MATURITY DATE: NOVEMBER 3, 2013 ANTICIPATED ANNUAL PREMIUM: $12,000.00 INITIAL PREMIUM DEPOSIT: $1,000.00 BENEFICIARY ELLEN A BOND PREMIUM ae Schedule: ANNUALLY PREMIUM Payable as follows ON THE DUE DATES PRIOR TO MATURITY Beginning: Month Day Year Total PREMIUM: JANUARY 3 1989 $12,000.00 INDIVIDUAL DEFERRED This contract is signed at the home office of ANNUITY CONTRACT WITH Jackson National Life, Lansing, Michigan FLEXIBLE PREMIUMS DEATH BENEFIT PRIOR. TO MATURITY. MONTHLY INCOME AT MATURITY. Le NON-PARTICIPATING Secretary President. A307 CONTRACT PROVISIONS SECTION PAGE Basic Benefits □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ OD General ProviSiONns □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ O Accumulated Value Provisions □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ A Annuity Provisions □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ Settlement Option Table □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ 6 Form No. 3007 DA 7/82 Page 2 BASIC BENEFITS THE COMPANY WILL PAY the Annuitant, if living on the Maturity Date, a monthly life income annuity with 12( months certain. The amount will be as shown on the Table of Guaranteed Values page of this Policy or such greate amount as determined by the terms of this Policy. Upon receipt of due proof of the death of the Annuitant prior to the Maturity Date, the Company will pay to th Beneficiary, no later than two months after receipt of such proof, the Death Benefit Proceeds. The Death Benefi Proceeds will be equal to: 1) the total amount of premiums paid without interest and reduced by the sum of all Partial Withdrawal Amounts; or 2) the Accumulation Value, if greater. GENERAL PROVISIONS OWNER OF THE POLICY While the Annuitant is MISSTATEMENT OF AGE OR SEX If the age or se? living, all rights of this Policy belong to the Owner. The of the Annuitant has been misstated, the benefits availabl Owner may exercise these rights subject to the interest of under this contract will be those which the premiums pai any Assignee or irrevocable Beneficiary. would have purchased at the correct age and sex. CHANGE OF OWNERSHIP The ownership of this Any underpayments will be made up immediately by th : . ..,, Company. Overpayments will be deducted fron Policy may be changed at any time during the Annuitant’s di t lifetime. Such change must be made by written notice succeeding, Payments as necessary. acceptable to the Company. A change will take effect on CONSIDERATION: ENTIRE CONTRACT Thi the date the notice is signed. However, the change will not consideration for issuing this Policy is the Application an apply to any payments made or actions taken by the the payment of the first premium. This Policy and th Company before the notice was received at the Home Application, a copy of which is attached and made a part o Office. The Company reserves the right to require that this the Policy, constitute the entire contract between th Policy be presented for endorsement of any change. parties. All statements made in the Application will, in th HOW BENEFICIARY MAY BE CHANGED While absence of fraud, be deemed representations | and no . os warranties; and no statement will void this Policy or b this Policy is in force, the Owner may change the vs . □ . : used as a defense to a claim unless it is contained in suc! Beneficiary, unless otherwise provided by endorsement. ten applicati This may be done by filing at the Home Office of the written applicalion. Company an acceptable written request. Such change will MODIFICATION OF POLICY Only the President, | be subject to any existing assignment of this Policy and Vice President, the Secretary, or an Assistant Secretary o will take effect only when recorded by the Company at its the Company has power on behalf of the Company t Home Office. When recorded, the change will take effect change, modify, or waive the provisions of this Policy an on the date the notice was signed. Any proceeds paid then only in writing. No agent or persons other than th before a change of Beneficiary is recorded will not be above named officers has the authority to change or modif subject to the change. this Policy or waive any of its provisions. DEATH OF BENEFICIARY The interest of any ISSUE DATE Unless otherwise stated on the face o Beneficiary who dies before the Annuitant will end at the this Policy, the issue date will be the date used t death of the Beneficiary. The interest of any Beneficiary determine due dates, policy anniversaries and policy years. who dies at the time of or within ten days after the death of CHANGE OF ANTICIPATED MATURITY DAT} the Annuitant will also end if no proceeds have been paid : □□ . . . While this Policy is in force, the Owner may change th to that Beneficiary. If the interest of all designated Antici . nticipated Maturity Date to a date later than that show: Beneficiaries has ended, any proceeds will be payable to : . : . on the face of this Policy by filing a written request at th the estate or legal successors of the Annuitant. : Home Office of the Company. NONPARTICIPATING This Policy will ne participate in the profits or surplus of the Company. Form No. 109 DA 11/86 Page ACCUMULATED VALUE PROVISIONS ACCUMULATED VALUE The Accumulated Value is When a Partial Withdrawal is made, the Partia equal to the Net Amount of each premium, less all Partial Withdrawal Amount will be taken from the Accumulate: Withdrawal Amounts, accumulated at interest and reduced Value arising from the first-year premium and interes by the Annual Administrative Charges if applicable. thereon before any other premiums and interest. Interest will be credited from the date a premium is FULL WITHDRAWAL At any time prior to th received by the Company and will cease to be credited on Maturity Date, the Company will, upon written □□□□□□□□□□□ Partial Withdrawal Amounts on the date the Partial by the Owner and surrender of the policy, pay to th Withdrawal is granted by the Company. Owner the Cash Surrender Value of the policy. ADDITIONAL PREMIUM PROVISION The SURRENDER CHARGE The Surrender Charge is | Company will accept additional premium payments after percentage of the Accumulated Value of the first-yea the initial payment at any time prior to the election of an premium and interest thereon for either a Full Withdrawa annuity payment option and in any amount not less than or Partial Withdrawal. The Surrender Charge percentage $50. policy year is shown on the Policy’s Table of Guarantee: If premium payments are discontinued, the existing Values page. Accumulated Values will continue to accumulate as The Company may defer payment of any withdrawa described in the “Accumulated Value” section. amount for a period not exceeding six months. ANNUAL ADMINISTRATIVE CHARGE At the end ANNUAL STATEMENT OF VALUES The Compan: of each policy year, an administrative charge of $20 will be shall provide to the Policyowner annually a statemen deducted from the Accumulated Value of each contract on showing premiums paid, partial or full withdrawals grante which premiums had been paid in the policy year. Except and the then current accumulation and cash surrende that such charge will be waived in each year in which values. premium payments total at least $1,000. INTEREST OF THE OWNER The interest of thi NET AMOUNT OF EACH PREMIUM The Net Owner in the Accumulated Value prior to the Maturit Amount of each premium is equal to the total premium Date will at all times be nonforfeitable. received by the Company reduced by the applicable INTEREST Interest will be credited to th premium tax rate in effect on the date the premium is Accumulated Value from the date premiums are receive received and reduced by a collection charge of $1.25. This by the Company until withdrawals are granted by th collection charge will be waived and not deducted from Company. The rates of interest will be as the Board o any premium which equals or exceeds $1,000. Directors of the Company may declare, in advance. Sucl CASH SURRENDER VALUE The Cash Surrender rate of interest will never be less than the rate shown on th Value is equal to the Accumulated Value, less the Table of Guaranteed Values page. Such interest credite Surrender Charge. which exceeds these rates will be excess interest and wil PARTIAL WITHDRAWAL AMOUNT The Partial be added to and become part of the Accumulated Value Withdrawal Amount means any amount less than the Cash On contracts where less than $1,500 of premium has bee: Surrender Value, which is withdrawn from the paid during the most recent 24 months, the Board o Accumulated Value. Directors may declare lower or no excess interest. NET WITHDRAWAL AMOUNT The _ Net RESERVE BASIS The reserve under this Policy prio Withdrawal Amount is equal to the Partial Withdrawal to the commencement of any annuity payment will b Amount less the Surrender Charge. equal to the Cash Surrender Value then current, or th PARTIAL WITHDRAWAL At any time prior to the greatest of the discounted future Cash Surrender Value Maturity Date, the Owner upon written application, may discounted at the valuation interest rate permitted by law withdraw a Partial Withdrawal Amount, subject to the whichever is greater. After that, the reserve will equal th terms of this Policy. The Partial Withdrawal Amount must present value of future annuity benefits provided. be such that the remaining Accumulated Value after The Cash and Annuity Values provided under thi withdrawal is not less than 15 percent of the Accumulated Policy meet or exceed the minimum levels required by th Value immediately prior to the Partial Withdrawal. In no laws of the state in which this Policy is delivered. / case may the remaining Accumulated Value be less than detailed statement of the method of computing values ha $1,000. been filed with the supervisory official of the state wher this Policy is delivered. Form No. 253 DA 11/86 Page 4 ANNUITY PROVISIONS ANNUITY BENEFITS At the Maturity Date selected there are less than 120 monthly payments, the Cas} by the Owner, the Accumulated Value will be applied to Surrender Value will be applied instead of th provide an annuity payable for 120 months certain and life Accumulated Value. Payment under this Option is subjec as determined from this Policy, or other more favorable Satisfactory proof of the age of the Payee. options as the Company may make available. ‘The Owner MINIMUM PAYMENTS | ! he minimum paymen : os . under Option 1 is $100. The minimum payment under any may elect to receive an annuity in accordance with the yt ns . : . of the other Options is $25. other Options shown in the Policy or made available by the EFFECT OF TAXES ASSESSED AT MATURITY Company. At the death of an Annuitant before the Maturity OR TIME OF ELECTION OF AN OPTION In the even Date, the Beneficiary may elect to receive an annuity by a premium tax or other tax is assessed at the time payment: applying the death benefit proceeds under any of the begin, the amount of such tax will reduce the proceed: following Options or other more favorable Options as the which would otherwise be applied. Company may make available. Election of an Option must EXCESS INTEREST Excess Interest as declared by be made in writing to the Company. The effective date of the Company may be used to increase payments or t any election of an Option will be determined by the increase the period of time for which payments are made. election. ELECTION OF SETTLEMENT OPTIONS BY) PAYMENT OPTIONS The proceeds may be applied OWNER T he Owner may elect or change any paymen , □□ option during the lifetime of the Annuitant. The election o under any of the following Options: sh van b deb itt tice to the C. OPTION 1 - PROCEEDS AT INTEREST The Cash ““SPECtON. OF PAYMENT OPTIONS. BY Surrender Value or the Death Benefit Proceeds may be left peNERICIARY If no payment Option is in effect at th on deposit during the lifetime of the Payee or for a death of the Annuitant, a payment Option may be electec specified period. Interest will then be paid annually. The by the Beneficiary. The election can be made by □□□□□□ rate of interest will be no less than 4% per year. All or part notice to the Company. of the proceeds may be withdrawn at any time. ADJUSTED AGE The adjusted age is determined fron OPTION 2 - PAYMENT FOR A FIXED PERIOD | the actual age and the calendar year of birth. The Accumulated Value or the Death Benefit Proceeds Calendar Year of Birth Adjusted Age may be paid in monthly payments, until the proceeds plus Before 1900 Actual age Plus 2 interest at no less than 4% per year are paid in full. The 1900-1919 Actual age plus 1 period is shown in the table. If there are less than 120 1920-1939 Actual age monthly payments, the Cash Surrender Value will be 1940-1959 Actual age minus | applied instead of the Accumulated Value. The present 1960-1979 Actual age minus 2 value of any unpaid payments may be withdrawn at any 1980 and After Actual age minus 3 time and will be if a Payee dies before the last payment is AVAILABILITY OF OPTIONS These Options are no made, available if the Beneficiary is an Assignee, Corporation OPTION 3 - LIFE INCOME The Accumulated Value rang Fide oye Trustee, Executor, Administrato or the Death Benefit Proceeds may be paid in monthly "FREQUENCY OF PAYMENTS The payments show: payments during the lifetime of the Payee. A munimun in the table are monthly payments. Payments may be mad number of payments may be guaranteed if desired. The one, two or four times per year if desired. These payment amounts of the monthly payments are shown in the table. gre obtained as follows: They are based on the 1971 Individual Annuity Mortality Number of Payments Per Year Method of Calculation Table with interest at 6%. Payment under this Option is One Monthly Payment Multiplied subject to satisfactory proof of the age of the Payee. If the by 1.787 0 : Two Monthly Payment Multiplied Payee dies before the guaranteed payments have been paid, by 5.951 the present value of the remaining guaranteed payments Four Monthly Payment Multiplied will be paid. by 2.990 The present value of any unpaid payments under any option will be calculated using 4% interest. OPTION 4 - CURRENT ANNUITY OPTION The Accumulated Value or the Death Benefit Proceeds may be used to purchase any single premium immediate annuity which is issued by the Company on the date of election. If Form No. 327 DA 11/86 Page § TABLE OF ANNUITY OPTIONS The following table is for a contract whose net proceeds are $1,000, and will apply pro rata to the amount payable under this policy. OPTION 2 MONTHLY INSTALLMENT UNDER OPTION 3-CONTINUOUS INSTALLMENTS No of Monthly Adjusted Age No. of Mos. Certain Adjusted Age No. of Mos. Certain Adjusted Age No. of Mos. Certain | Install- of Payee of Payee of Payee Install- ments ments | Male | Female | tite | 120 | 240 | Male | Femate | vite | 120 | 240 | male | Female | Lite | 120 | 240 12 $84.84 26 $4.93 | $4.92 | $4.91 441 47 $5.53 | $5.49 | $5.39 62 68 $7.46 | $7.08 | $6.33 24 43.25 27 4.94 4.94 4.92 | 42 48 5.58 5.54 5.43 63 69 7.62 7.20 6.37 36 29.40 28 4.96 4.95 4.94 43 49 5.63 5.59 5.46 64 70 7.80 7.33 6.42 48 22.47 29 4.98 4.97 4.95 44 50 5.69 5.64 5.50 65 71 7.99 7.46 8.46 60 18.32 30 5.00 4.99 497 | 45 51 5.75 5.70 5.54 66 72 8.19 7.60 6.51 72 15.56 31 5.02 5.01 4,99 46 52 5.82 5.75 5.58 67 73 8.41 7.74 6.54 84 13.59 | 26 32 5.04 5.03 5.01 47 53 5.89 5.81 5.62 68 74 8.65 7.88 6.58 96 12.12 | 27 33 5.06 5.05 5.03 | 48 54 5.96 5.87 5.66 69 75 8.90 8.04 6.61 108 10.97 | 28 34 5.07 5.07 5.05 49 55 6.03 5.94 5.71 70 76 9.18 8.19 6.64 120 10.06 | 29 35 5.10 5.09 5.07 50 56 6.11 6.00 5.75 71 7 9.48 8.35 6.67 132 9.31 30 36 5.12 5.11 5.08 51 57 6.19 6.07 5.79 72 78 9.80 8.51 6.69 144 8.69 31 37 5.15 5.14 5.10 52 58 6.28 6.14 5.84 73 79 10.15 8.67 6.71 156 B17 | 32 38 5.18 5.17 5.13 53 59 6.37 6.22 5.89 74 80 40.52 8.83 6.73 168 7.72) 33 39 5.21 5.20 5.15 | 54 60 6.46 6.30 5.94 75 10.93 9.00 6.74 180 7.34 | 35 40 5.24 5.23 5.18 | 55 61 6.56 6.38 5.98 76 41.37 9.16 6.75 192 7.00 | 35 4 5.27 5.26 5.21 56 62 6.67 6.47 6.03 7 11.85 9.31 6.76 204 6.71 36 42 5.34 5.29 5.24 57 63 6.78 6.56 6.08 78 12.37 9.47 6.76 215 6.44 | 37 43 5.35 5.33 5.26 | 58 64 6.90 6.65 6.13 79 12.93 9.62 6.77 228 6.24 38 44 5.39 5.37 5.29 59 65 7.03 6.75 6.18 80 13.54 9.76 6.77 240 6.00 | 39 45 5.43 5.41 5.33 | 60 66 7.16 6.86 6.23 40 46 5.48 5.45 5.36 61 67 7.30 6.97 6.28 No. 328 DA 11/86 Page 6 JACKSON NATIONAL LIFE INSURANCE COMPANY 1 Corporate Way Lansing, Michigan 48951 ® TABLE OF GUARANTEED VALUES PLAN: FLEXIBLE PREMIUM DEFERRED ANNUITY ISSUE AGE - 50 MALE POLICY NO: 0004865310 ANNUAL PREMIOM - $12,000.00 THE VALUES SHOWN BELOW ARE BASED ON THE PREMIUM SHOWN ABOVE, PAID ANNUALLY IN ADVANCE ON EACH POLICY ANNIVERSARY, AND ON THE GUARANTEED ANNUAL INTEREST RATE, SINCE INTEREST IS CREDITED ON THE ACTUAL NET AMOUNT OF EACH PREMIUM PAYMENT FROM THE DATE IT IS RECEIVED, THE VALUES OF THIS POLICY WILL VARY ACCORDINGLY. THESE VALUES WILL BE INCREASED BY ANY AMOUNTS OF EXCESS INTEREST DECLARED BY THE BOARD OF DIRECTORS AND WILL BE REDUCED BY ANY PARTIAL WITHDRAWALS. END OF ACCUMULATED CASH. GUARANTEED MONTHLY POLICY VALUE SURRENDER INCOME LIFE ANNUITY WITH 10 YEAR VALUE YEARS CERTAIN AT AGE 70 1 $12,360.00 $8,034.00 $117.50 2 $25,090.80 $20,635.02 $349,84 3 $38,203.52 $33,614.07 $517.15 4 $51,709.63 $46,982.49 $679.60 5 $65,620.92 $60,751.97 $837.31 6 $79,949.55 $75,364.39 $990.42 7 $94,708.04 $90.428.08 $1,139.08 8 $109,909.28 $105,956.96 $1,283.41 9 $125,566.56 $121,965.39 $1,423.53 10 $141,693.56 $138,468.16 $1,559.57 1] $158,304.37 $155,646.64 $1,691.66 12 $175,413.50 $173,360.49 $1,819.89 13 $193,035.91 $191,626.12 $1,944.39 14 $211,186.99 $210,460.95 $2,065.26 15 $229,882.60 $229,882.60 $2,182.61 16 $249,139.08 $249,139.08 $2,296.54 17 $268,973.25 $268,973.25 $2,407.16 18 $289,402.45 $289,402.45 $2,514.55 19 $310,444.52 $310.444.52 $2,618.82 20 $332,117.86 $332,117.86 $2,720.05 AGE 60 $141,693.56 $138,468.16 $1,559.57 AGE 70 $332,117.86 $332,117.86 $2,720.05 THE SURRENDER CHARGE PERCENTAGE BY POLICY YEAR IS AS FOLLOWS: * FIRST 5 POLICY YEARS 35% 9TH POLICY YEAR 23% 13TH POLICY YEAR 8% 6TH POLICY YEAR 32% 10TH POLICY YEAR 20% 14TH POLICY YEAR 4% 7TH POLICY YEAR 29% 11TH POLICY YEAR 16% 15TH AND LATER 8TH POLICY YEAR 26% 12TH POLICY YEAR 12% POLICY YEARS 0% * APPLIED TO ACCUMULATION OF PREMIUMS PAID IN FIRST POLICY YEAR ONLY THE GUARANTEED INTEREST RATE IS 3.00% COMPOUNDED ANNUALLY. A307 Ho APPLICATION TO A 082907 ’ JACKSON NATIONAL LIFE INSURANCE COMPAINY / LANSING, MICHIGAN a FOR FLEXIBLE PAYMENT ANNUITY CR SINGLE PAYMENT ANNUITIES, 4 -1.Full name of Annuitant (First, Middle and Last Name) ‘7 PLEASE PRINT aU Uy 5 Bk ay Sex >t _ Mate □ Pele Pl el iol TLL Ti titi □□□ Teme, 2 Addrass Number and Street ~ State Zin Coda Minus Dee Syworewo len |¢zvo ‘| 8, Dale of Birth Month | Day Year = | peibemaunyy Nuno (rust be filed in) 2. - (SBF SO cary! 2! 4. Employer Uccupalio ros Hale Employed Focus 2000 REAL ESTATE OFVELOER | 7 Baneticia Siam = lf onbngant Benehciary □ | Relatonshi Pat. derh! ge BOK D 30a OsEL fencer T. Got%) 3 oA) is understood that ownership and contro! of the Contract to ha issued on tne basis of this statement will be vested in O The Annutant 3 Other than the Annutant Fae tA ey Zoee {SHOW NAME, ADDAESS, AND SOCIAL SECURITY ; OR BUSINESS IDENTIFICATION NUMBER tf LIM ISB-O28 7TH 7 OWNER iS OTHER THAN anUTANT ee Payment Notice to: (if other than Ho 2 above Nama Number and Stet PF OLYS aooe d State Zip Code PHIe/P BowNTRUSTE \ires c1sdway OR, Shy 1@O |cA $2IIO 8. THIS APPLICATION IS FOR A PLAN CODE 12 Qurer Retains Richt : FLEX Ii ANNUITY 822 fo cnange Beneficie y Yes A’ No the annully purchased on a lac-qualihed Basis? We ho AnopaedRemomiage TCS” 14 Is ths Conttact to replace any exuting A lifa insurance pobcy or annuity pohcy? □□ Yes □□ ‘WT contract Ts purchased to fund @ qualihed plan, please indicata If $0, gve Completa detats appropriata section of Internal Revonue Code 0 IRA (Saction 408) □ O Seif Employed (Section 401 Ti Sjanal Aegueas. ecm Anat Sete ae "AMULTALY RETAINS RIGHT rqanization (Sectron 0) Public Schoo! System (Section 403b Te ARGE FEMEFICIARY O Betetred Compensation (Plan Document Enclose 20S ee ee □ O Simplified Employee Fension (Section 408) . : 11, Payment Intormation for Flexibla Contract 4} § & 53 [ _—a.tnital Payment § ff @ee@ b. Anticipated sna oanen Séaky ONG f . □ Mode of Payment (Circle One) (A) S QO PAC BOP JAH O3 1729 □ IMPORTANT: MAKE ALL, CHECKS PAYABLE ONLY TO JACKSON NA AL LIFE INSURANCE CO, GENERAL INFORMATION Nole that: 1, The acceptance of tha Comract issued on this appticalion shallconshtuta 3 Upon acceptanca of a Contract other than as applied for, this applica □ aralification of any change correchon or addon made by the Com- bon {including <iny enio’sements in 16 above) shallbe for sach modified □ pany and noted in the space headed "Homa Olfice Endorsements” Contract, excep! that wdite tequited by statute of Insuranica Department □□ 2. There has been celivered to the agant with this apphcation tegulation any change i plan, amount, Classification o benefits shail □ sf fines opal only to Jackson National Life insur- be made only upea written agreement, 2 - bad ance which shail not be considered payment hereunder unless 4 The undersigned hereby represents In the bast of his (Ihelty knowledge □□ actually honored upon preseniation by the Company in the due course that each of tha statements and answers contained above are com- □ of business plete and (nue, □ : Cash Received Daled and | With Application $f @G@s— Signed at Suv Die CA on fee 22 □□ cy Wf eye 54098 WY IG : ereatain. MOB Seg AGO ween eter | Sag □□□ AGS Taig ager AR a Cael en tad Q = TOSI □□ . Form No, 9288 REV. 11/82 - Ba 2020-02-21 11354 Costco W 130 sign 3236611475 >> FAXCORE P 1 To: Jackson National Life Insurance Company From: Gregory Bond Re: Policy #0004865310, Philip Bond Date: February 21, 2020 Attached: 1) Copy Of Jackson Letter Dated February 6, 2020 - 1 Page 2) Claim Form - 8 Pages 3) Certified Death Certificate - 1 Page 4) Certified Marriage Dissolution - 27 Pages Total of 37 Pages + Cover Sheet Fax to: (517) 706- 5513 2020-02-21 11:54 Costco W 130 sign 3236611475 >> FAXCORE P2 (02/21/2020 15:07:06 JACKSON NATIONAL LIFE INSURANCE COMPANY Adnunisiration February 6, 2020 Ellen A Bond Gregory T Bond 29506 Mammoth Ln Canyon Country, CA 91387 |URGENT: IMMEDIATE REPLY REQUIRED | □ Deveased: Philip G Bond Policy 9004865310 Dear Ellen A Bond; One mvurds waionts thee 00 BAA, Bawds techs el tae Ui lecinal Pods uy to Ui braid y all lee above listed policy with an approximate value of $8,050.64, To date, we have not reccived the following documents necessary lor consideration of his claim, + Clair Form * Final Certified Death Certificate This property may be cacheated to the state if the beneficiary docs mot come forward to clair the funds. YOUR RESPONSE MUST BE RECELVED WITHIN 30 DAYS FROM THE DATE QF ‘THIS LETTER to prevent these funds [rom being reported to the state of California as unclaimed property, LE you have additional questions or concerns, please contact our Service Center at 888/565-4995, Monday through ‘hursday, 8:00 a.m, to 7:00 p.m. and Friday $:00 a.m. to 6:00 p.m. (ET), You may also contact Jackson via cmail through "Contact Vs" on ow website at www. jackson.com. Sincerely, ( aura. Lei tie: Laura Hansen VP, Policy Owner Services Jackson Mational Life Tnsarance Company 1 Corporate Way, Lansing, MI 48991 HUUG44-4565 ea ae ut ne Coe. eiecreree Meas □□ = 2020-02-21 11:57 Costco W 130 sign 3236611475 >> FAXCORE == PON □□□ □□ Oe HOS te ara RESTS STRICTO COND OR □ i rae i aha. □ DAG: ie he ie, TH EH 1 iter aI fii ra a At i a IF VTech □□ is) Ci ea hi ie) ti nye es hs ee ah □□ □□□ □ □□ 3 : M3 ti Wee bea Serre oe a piece oh te rere Bt Mee) ips es a +a □□ ae FAP PS ES ON NP meee AE EP TEN, OP VAN RTO NS Ce Sl Ne ey □□□ □□ sear” Oey □□ Seman □□ □□□□ □□ □ moe) ERNEST J. DRONENBURG, JR. =~ □□□ □□□□ ASSESSOR/RECORDER/COUNTY CLERK □□ ee □□□□ te he Me CERTIFICATE OF DEATH 3201837011714 □□ rr tence — □□□ That Eee □□□ □□ na ma □□□ Pea TAILLP ELE LE aT a iices □□ aur □□□□ 5 Lite Coes = LO Ae | CA PORES | a, PRAY pe Pe wt BA Gail een □□□□ cane =| nt aoa we Geer a a Py ea Ga a ve Tm oO ona a | ao Ra Aa ap eT i Te | □□ POSES ST PS Pace ened Pua, oe Mera □□□□□ 3780 VISTA CAMPANA 5 #8 □□ ‘i no Sear ToPanne Ta VERSOTCEMmNTY | Ga WE EOIN Dea □□□□□ Seoseoe ane ee lek Eilromisono.wre «(ROWAN EAMUPAIC Sa SORANERE NERS ae a SE er ae Tannen □□□ RUTH CLARA SCHULTZ □ Tao iain iver ae □□□□ eet oF eS □□□ a arcane dome □□ | RRMeReRORT renee [AnicecrrnC ROSS OMA LINDA UNIV, GOUIES FOR SCIENCE □□□ : Oriaeo18 24780 STEWART ST,, LOMA LINDA, CA 02350 □□ ib rene areas PGunnEE ae wie □□□□ ae □□ ee ean vate! refi ah Eases DOR Pl =? □□ [SARRENTOVALEY Mortuary [Foimes” waumaswooren,wowen §@ [cram ae Th Rane SFR eS = Goan IT re □□ gylwsraraou sreciazencarercume |e Deel Jolin bate Clee Cen ae ar Ear? GL) Eee Se PE SSS ia ory □□□□ areas = = □□□ G309 Seika Sele | See □□ C309 |secoesewtt wALZHEMERS DEMENTIA ers O= be a □□□ a T= Oh re Peer □ □ [eam i [ke □□ Elster. fe □□ A ieee □□□ ‘a (eos □ Teg cr OTR WOO TR TORE CEST - bee □□□□ ae SRRTRSTTE FHETT = a | eer ea cee caer SESE | i Wt ye or 7 OP RUM | cee □□ i] etcmeevie feantnjoe, | PHOUSSAM BAROUDI, MU Soar ln NeeeOIe □□□□ ie 1 ee a eae apy UL LTT TA : MO □□□ Elowenzois joweazois —_—| 1026 VIA CENTRE. VISTA, GA a206t 1. Tho Peal Pie Ciba area BATE, ee AL Pe De eres i c eee wbet a □□□□□□ [acre Juve Come ore Cee Die Coecss |e Oe Om | □□ Deegan capugecoe ee a ee | fu hls NL □□ □□ ar le ar, ce, WT Pa □□□ □□ □□□ SCRE eR TE Te aA ie A i □□□ z= or □□ =. naan This ts a truc and cxact reproduction of the document officially renistered and placed on file in the office of the □□ □ San Diego County Recorder/Clork □□ * * □□ □□□□□ □□□ □□ □□ a if Sin STE □□□ □ □□ att, Sep 21, 2017 Emest J, Dronenburg, Jr. Lire □□□ mo Assessor/Recorder/County Clerk Ha hone □□ tenet NAVINI Fe □□ eet I =, This copy is not valid unfoss propared on an engraved border eae gos □□□ □□□□□□□ alk ‘a a ies displaying date, seal and signotnre of the Recorden'County Clerk O04478428 fea 2 bk □□ □ □□□ artnet Bch omaha □□□ □□□ [a alls oneaa □□□ Tale Mla an al ee alae hae pee ao Cc □□□ 2020-02-21 11:58 Costco W 130 sign 3236611475 >> FAXCORE P 12/38 02/21/2020 15:07:06 : i 2" , i PTTORNET GM Pa OUT ATTORNEY (izaa pgp scaage), (619) 2088 ene □ David M. Huffman HUFFMAN & KOSTAS 4420 Kettner Blvd., Ste. 402 san Diego, CA 92101 : TOME FoR: ELLEN BOND ‘ wnmGIO27 6 SUPERIOR COURT OF CALIFORNIA, COUNTY.OF SAN DIEGO Far □ [3é_] FAMILY COURT BUILDING, 1501-55 SIXTH, SAN DIEGO, CA 92101-1046 = nore COUNTY BRANGH, 325 5. MELROSE, VISTA, CA 92083-8627 EAST COUNTY COURT, 250¢ MAIN, EL CAJON, CA 82020-9013 SEP 2 4 1998 |__| SOUTH BAY COURT, S00 THIRD, CHULA VISTA, CA 21970-4504 MARRIAGE OF By: A. MBYER-JAGQUES, Deputy petitioner, ELLEN A. BOND FAMILY COURT RESPONDENT; PHILIP G. BOND EASE NUMBER; You are notified that the following judgmant was entered on (oote): SFP 7 8 1998 1. GE) Olssotution of Marriage 2 (J Dissotution of Marriage - Status Only . 3. CO Dissolution of Marriage - Rasarying Jurisdiction over Termination of Marital Status 4. Legal Separation 5 Multity 6 Other (epecity): omar gep 24 1088 Kime 6 Waident, KENNETH E. MANTONE CLEAK OF THE SUPERIOR COURT = NOTICE TO ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY - Purgyvant to the provisions of Code of Civil Procedure section 162, if no appeal ls filed the Court may orcer tha exhibits destroyed or otherwise disposed of after GO days from the oxplration of the appeal time. . Effective date of termination of marital atatus (specify): SEP 18 1998 WARNING: NEITHER PARTY MAY REMARRY UNTIL THE EFFECTWE DATE OF THE TERMINATION OFF MARITAL STATUS AS SHOWN IN THIS BOK. CLERK'S CERTIFICATE OF MAILING I certify that | am nota party to this cause and that a true copy of the Notice of Entry of Judgment was mulled first class, postage fully prapald, in a sealed anvelope aderessed as shown below, and that the notice was malled at (place): , California, ETH E, MARTON -. on ae CLERK Of THE GOURT Date: A by 2: , Dapuly ELLEN A. BOND PHILIP G,. BOND a David M. Huffman | a Industry St., Unit B HUFFMAN & KOSTAS Oceanside, CA 92054 1420 Kettner Blvd., Ste. 402 San Diego, CA 92101-2433 Aidell Gouna Caton NOTICE OF ENTRY OF JUDGMENT SUPCTOA21 (Rev. 7-25) Sramy Lam) □ 2020-02-21 11:59 Costco W 130 sign 3236611475 >> FAXCORE P 13/38 02/21/2020 15:07:06. ry THOANEY OF PANTY WITHOUT, ond TELEPHONE Wer FOR COURT LET ae ————_—e (619) 544-0880 David M. Huffman “ * □ HUFFMAN & KOSTAS 1420 Kettner Blvd., Ste. 402 ‘ Ban Diego, CA 92101 69026 BY. t € Dp aronnev (ine): ELLEN BOND when E. MARTONE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO Clark oF thy Sunes Court omcersnores; 1501-55 SIXTH AVENUE 5 □ wuss: P.O. BOX 128 SEP 18 1998 crvwozecoe, SAN DIEGO, CA 92101 onmscn won: EAMT LY LAW DIVISION 304 0? 22 GOULING, Dany □□ MARRIAGE 0 (2? O40 Ist Porer Fee #185..06 PETITIONER: ELLEN A. BOND . responneNt: PHILIP G. BOND JUDGMENT Ce ar Cipescntion [J egal separation _[__) nutty D 495886 □□□ Statue on Jurisdiction over termination of marital status 0) Date marital atatun ends: SEP 7 8 1998 1. This wag hoprd es follows: [__] datauit or uncontostod [31] by declaration under Fam Code, § 2396 (__] contestod □ a. bate: SEP 1 8 1998 Dept: fim: □□ b. Judge (name): William S. Gannon, Judge Cl Temporary judge c. cA Patitionar present In court [J mtorney presant In court (name): dh Hospondent pragent In court Attorney present in court (nama): a. L_] Ctaimant present In court (nome): attornay praesent in court (nama: 2 The court acquired Jurisdiction of tna respondent on (date); 04/27/97 □□ (30) Respondent was sarved with process [__] respondant apposred 4. THE COURT ORDERS, GOOD CAUSE APPEARING: □ a. (3) sudgmant of dissolution be entered. Marital stetueis terminatod and the parties arerestored to tha status of ynmaried persons □ (1) (XJ on the toliowing date (speci): SEP 1 & 1998 (2) LJ on a date to ba datarminad on mothced motion of alther party or on stipulation. □ b. [_] Judgment of egal separation antered c. bef susan of nullity be entered, Tho parties are doclarad to be unmarried persons on the ground of (speclty): Wite's former name be restored (specify; ELLEN A. IFSHILN a, L_] This judgment shall be entered nync pro tunc a of (cate): f. Pa areata if rosorved over al] otter euo9 and all prosent orders ramaln In affect oxcept as provided below. Other (speci); PLEASE SEE ATTACHMENT TO JUDGMENT OF DISSOLUTION WHICH I5 ATTACHED HERETO AND INCORPORATED HEREIN BY REFERENCE. h, Jurisdiction is reserved to make other ordars necessary to carry out this Judgment, Date: □□□□□□□□□□□□□□□□□□□□□□□□□□□ XMXXXXXXKXARERX ARKH JUBGG OF THE SuPERPOR CoouAT 4. Numbor of additional pages attachad: 24 (2271 signature follows tast attachmont P 2 NOTICE □ Ficase reviow your will, Ingurance policies, ratiramant banefit pinna, credit cards, other cradit accounts and credit raporta, and other matters you may want to change In view of the diagolution of annulment of your marriage. or your logal soperation. A dobt or obligation may be assigned to one party a9 part of the division of property and debts, but if that party not pay the debt or obligation, the crogitor may be able to collect from the other party. An carning’ afalgnment wil automatically be lasucd if child aupport, family support, or spousal gyppart ia ordored. Adopted by Rule 1207 JUD@MENT Pansy Code, 240, 203, 205 j 1207 (Rov. January, (Family Law) □ 2020-02-21 11:59 Costco W 130 sign 3236611475 >> FAXCORE P 14/38 is 207:06 i & é MARITAL SETTLEMENT AGREEMENT The parties to this Agreement, PHILIP G. BOND, hereinafter referred to as "Husband", and ELLEN A. BOND, hereinafter referred to as "Wife", agree as follows: 1. STATISTICAL INFORMATION: a. The parties were married on September 17, 1989. bh, There were no children of this marriage. a. Irreconcilable differences have arisen between the parties and these differences have led to an irremediable breakdown - of their marriage. Thus, the parties have separated and agreed to live free from any interference by the other. a. The parties separated on April 18, 1997, which is elght (8) years, six (6) months from the date of their marriage. They have not resumed their marital relationship since the date of separation. e. There is presently on file in the Superior Court of the State of California, County of San Diego, an action for the dissolution of the parties’ marriage filed as Case Number D 435556. The Petition was filed by Wife on April 18, 1997. Husband executed a Notice and Acknowledgement of Receipt on April 27, 1997. The . Notice and Acknowledgement of Receipt which was executed by Husband was filed with the Court on May 13, 1997. 2. PURPOSE OF THIS AGREEMENT: The purpose of this Agreement is to make a final and complete settlement of the parties’ rights and obligations pertaining to: . By Zh PGB E Page 1 of 24 2020-02-21 11:59 Costco W 130 sign 3236611475 >> FAXCORE P 15/38 [0708] MS ® € a. Identification and designation of their respective separate property and separate obligations; b. Identification and division of their community or co-owned property and community or co-owed obligations; ec. Spousal support; and d. Attorney fees. This Agreement also setu forth specific matters over which a Court of competent jurisdiction shall retain jurisdiction. 3. SEPARATE LIVES AND PROPERTY: a. The parties shall live separate and apart and except for the duties and obligations imposed and assumed under this Agreement, each shall be free from interference, authority, and control of the other as fully as though he or she were single and unmarried. Each party may conduct, carry on, and engage in any employment, profession, business, or trade which to him or her may seem advisable for his or her own use or benefit without, and free trom, any control, restraint, or interference, direct or indirect, by the other party and in all respects as if each were unmarried. b. Except as expressly provided to the contraxy in this Agreement, any property acquired by either party from or after the date of separation shall be the sole and separate property of the one acquiring it. Each party waives any and all rights in or to such property and confirms it to be the sole and separate property of the party acquiring it from and after the date of separation. The earnings from personal services of either party after the date of separation shall be the sole and separate property of the one □ acquiring them. PGB □ Page 2 of 24 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 16/38 92/24/2020 35:07:06 : sm c. Except as expressly provided to the contrary in this Agreement, any obligation incurred by either party from or after the date of separation shall be the sole and separate obligation of the party incurring it, and the party shall assume, pay and hold the other party harmless from any obligation so incurred. 4. SPOUSAL SUPPORT: a. Husband's obligation to provide spousal support to - Wife is terminated effective forthwith. b. Wife‘s obligation to provide spotisal support to Husband is terminated effective forthwith. 5. DISCLAIMER OF REPRESENTATION RE VALUR: The parties hereto have acquired various personal and real properties of speculative value. It is understood by the parties that neither party makes any representations to the other as to the value of any property, community or separate, and each party relies on his or her own investigation and judgment with respect to all property and all matters covered by this Agreement. 6, HUSBAND'S SEPARATE PROPERTY: The following assets and/or . obligations are confirmed to Husband as his sole and separate property: a, Husband's clothing, jewelry and personal effects. b. Any bank accounts presently held in Husbands name. c. Husband/s earnings after April 18, 1997, and accumulations thereon. Wife acknowledges that she neither has nor claims any right, title or interest in any such property. Gah GZ Page 3 of 24 . 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 17/38 SOF US "ie é = 7. WIPE'S SEPARATE PROPERTY: The following assets and/or obligations are confirmed to Wife as her sole and separate property: a. Wife's clothing, jewelry and personal effects. b. Any bank accounts presently held in Wife’s name. c. Wife’s aarnings after April 18, 1997, and accumulations thereon. Husband acknowledges that he neither has nor claims any right, title or interest in any such property. 8. DIVISION OF COMMUNITY PROPERTY AND CO-OWNED PROPERTY: a. Husband and Wife hereby divide their community and co-owned property so that the aggregate fair market value of the community and co-owned property received by each is approximately equal, considering the apportionment of any community or joint liabilities. This division is fair and approximately equal, The community or co-owned assets of the parties shall be divided as follows: (1) Assets awarded to Husband. Husband shall receive, as his sole and separate property, the following assets: (a) The household furniture, furnishings and appliances in Husband's possession. (b) One-half (1/2) of the net proceeds from the sale of the real property located at 1425 Glenwood Drive, San Diego, California, 92103. ‘By execution of this Agreement, Husband authorizes Wife's counsel, David M. Huffman, to dishurse the proceeds in his segregated trust account one-half (1/2) to Husband and one-half (1/2) to Wife. Page 4 of 24 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 18/38 2/21/2020 33:07:06 ® (c) The 1984 Cadillac Coupe dé Ville automobile. (d) The 1967 Mercury Cougar automobile. (@) All right, title and interest in Husband’s business known as PME (Price, Manufacturing & Engineering). (2) Assets awarded te Wife. wife shall receive, as her sole and separate property, the following assets; (a) The household furniture, furnishings and appliances in Wife’s possession. (b} One-half (1/2) of the net proceeds from. the sale of the real property located at 1425 Glenwood Drive, San Diego, California, 92103. By execution of this Agreement, Wife authorizes her counsel, David M. Huffman, to disburse the funds in his segregated trust account one-half (1/2) to Husband and one-half - (1/2) to Wife. (c) The 1988 BMW 3251 automobile. (3) Husband has an IRA account with Bank of America, no. Pe which had a balance of $14,940.92 as of March 31, 1997. In order to equalize the division of community assets and debts, Husband shall forthwith transfer the sum of $10,000 from this IRA account into an IRA account in Wife’s name which will be designated by Wife. It is the parties’ intent that the rollover of $10,000 from Husband’s IRA account into an IRA account established by Wife shall constitute a nontaxabie event. If the Internal Revenue Service or the Franchise Tax Board for some . reason attempts to tax this transaction, the Court shall reserve jurisdiction over the allocation of any tax liability, Including ae Gg Page & of 24 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 19/38 4210708 HL: ® interest and penalties. The remaining balance in Husband's IRA account is awarded to Husband as his sole and saparate property. The $10,000 rolled over into Wife’s new IRA account is awarded to Wife as her sole and separate property. (4) By execution of this Agreement, Husband and Wife each represent to the other that they do not own any interest in any pension plan, profit sharing plan, IRA accounts or any other form of retirement benefits other than those specified in this Marital Settlement Agreement. 9. NO OTHER PROPZRTY: Each party warrants to the other that the warrantor does net own any property of any kind, other than the property set forth in this Agreement. If it later appears that either warrantor now owns any other property and that the warrantee has an interest in that other property, the warrantor shall transfer or pay to the warrantee, at the warrantee’s electloni a. An amount eaqual to the warrantee’s interest in such other property, if it is reasonably susceptible to division; b. The full market value of the warrantee’s interest on the effective date of this Agreement; or c. The full market value of the warrantee’s interest at the time the warrantee discovers the warrantor’s ownership in the property. This Agreement is not intended to impair the availability, in a Court of competent jurisdiction, of any other remedy arising from the undisclosed ownership of any property. 10. AFTER ACQUIRED PROPERTY: Any property acquired by either party from and after the date of this Agreement shall be the sgle Om Zaf PSB E Page 6 of 24 2020-02-21 12:01 Costco W 130 sign 3236611475 >> FAXCORE P 20/38 area ta SS ‘ * * . and separate property of the one so acquiring it; and each of the parties waives any and all property rights in or to such future acquisitions of property as the sole and separate property of the one 0 acquiring the same from the effective date of this Agreement. 11. NO_UNDISCLOBSED GIFwsS: Each party warrants to the other that the Warrantor has not made, without the warrantee’s knowledge and consent, any gift or disposition of community property other than a disposition in exchange for a vaiuabie consideration to the community. If it later appears that the warrantor made a disposition of community property contrary to this warranty, the warrantor shall pay the warrantee one-half (4%) of the fair market value of the community property measured, at the warrantee’s election: a. On the effective date of this Agreement; or b. At the time the warrantee discovers the disposition, less any appreciation in value attributable solely to the acts of the donee(s) and his successor(s),. This Agreement shall not impair the availability, in a Court of competent jurisdiction, of any other remedy arising from the undisclosed disposition of any property. 1i2. OBLIGATIONS: a. Wife shall assume the existing balance owed on the MBNA joan, no. a" in the approximate amount of $18,000. Wife shall use her best efforts to have the existing balance transferred into her name alone. If MBNA refuses to transfer the existing balance into an account in Wife’s sole name, Page 7 of 24 2020-02-21 12:01 Costco W 130 sign 3236611475 >> FAXCORE P 21/38 02/21/2020 15:07:06 yi Wife shall make the payments on this loan in a timely fashion and shall hold Husband harmless from any liability thereon. The □ parties each warrant te the other that there are no other outstanding unsecured debte for which the other may be liable. b. Any liability er obligation incurred at any time by either party and not expressly identified in this Agreement as payable in whole or part by the other party, shall be paid solely by the one incurring the liability or obligation. c. Except as may be expressly provided to the contrary in this Agreement, the party to whom an item of preperty is entirely allocated under this Agreement shall be solely responsible for all obligations incurred at any time relative to such item, including, but not limited to, any encumbrances, taxes and insurance against such item, and, except where otherwise provided in this Agreement, the parties shall be responsible for payment of their proportionate share of all obligations incurred at any time relative to any asset in which the parties both retain interests. d. The party responsible for payment of obligations pursuant to this section shall indemnify and hold the other harmless from all liabilities, costs and expenses relative thereto, including, but not limited to, reasonable attorneys fees and court costs which may be incurred by reason of the necessity to defend any claim or suit brought against the other party to enforce any such obligation. 13. HOLD HARMERSS PROVISION: In the event that a party to | this Agreement is required to pay and hold the other party harmless from some debt, and the party fails to hold the other party ee ay 42 Page 8 of 24 2020-02-21 12:01 Costco W 130 sign 3236611475 >> FAXCORE P 22/38 02/21/2020 15:07:06 "hy = © a and harmless from that debt, then the other party may pay some or all of such debt and deduct said payment from any monies owed by the other party to the party who breached the hold harmless covenant; provided, however, a party shall not pay the debt without first advising the other party of his or her intention to do so and waiting seven (7) days from the date such notice is given; and provided, further, the set off provided shall not be allowed with regard te any claim or demand as to which within said seven (7) day period the other party represents that he or she has a legal defense, unless and until the asserted legal defense is decided or settled adversely to that party. This remedy shall be in addition to any other remedies available for the enforcement of payment of debts. 14. CREDIT HISTORY: The parties agree that the credit history established by them during their marriage shall be deemed to have been the credit history of both parties, notwithstanding practices of creditors and credit reporting agencies which may have reported - such credit history in the name of Husband only or Wife only. Husband agrees ‘that he shall cooperate and execute all such documents as May be reasonably requested by Wife from time to time to enable Wife to provide her prospective creditora with the full eredit history of the parties during their marriage. Nothing herein shall be deemed as creating a liability of Husband for debts ereated by Wife on the basis of credit information obtained as deacribed above. Leg AS B Page 9 of 24 2020-02-21 12:02 Costco W 130 sign 3236611475 >> FAXCORE P 23/38 02/21/2020 15:07:06 ‘ 15. MOTUAL RELEASES: a. Except as otherwise expressly provided in this Agreement, each party releases the other and the other's heire and assigns, from any and all liabilities, debts or obligations and from any and all claims and demands, it being understood that by this present Agreement, Husband and Wife intend to sattle all aspects of their respective property rights or claims arising out of their marital relationship. b. Husband warrants to Wife that he has not incurred, | and he covenants that he shall not incur, any liability or obligation for which Wife is or may be liable, with the exception of any obligations identified in this Agreement. Husband covenants, except as may be expresely provided otherwise in this Agreement, that if any claim, action or proceeding shall hereafter be brought seeking to hold Wife liable on account of any of his debts, liabilities, acts or omissions, he shall, at his sole expense, defend her against any such claim or demand (whether or not well founded) and that he shall indemnify and hold her free and harmless from all costs, expenses and liabilities in connection therewith, including but not limited to, Wife's reasonable attorney fees and costs incurred by reason of the necessity to defend any such claim or suit. : c. Wife warrants to Husband that she has not incurred, and she covenants that she shall not incur, any liability or obligation for which Husband is or may be liable, with the exception of any obligations identified in this Agreement. Wife covenants, except as may be expressly provided otherwise_in this 4g GB & Page 10 of 24 2020-02-21 12:02 Costco W 130 sign 3236611475 >> FAXCORE P 24/38 02/21/2020 15:07:06 tye Agreement, that if any claim, action or proceeding shall hereafter be brought seeking to hold Husband liable on account of any of her debts, liabilities, acts or omissions, she shall, at her sole expense, defend him against any such claim or domand (whether or not well founded) and that she shall indemnify and hold him free and harmless from all costs, expenses and liabilities in connection therewith, including but not limited to, Husband's reasonable attorney fees and costs incurred by reason of the necessity to defend any such claim or suit, 16. SOCIAL SECURITY BENEFITS: The social security benefits of each party which are now or Subsequently declared to be community property, lf any, shall be declared to be the sole and separate property of the party who paid into the fund giving rise to such □ benefits. this Waiver by each party is not intended to prohibit any rights that may be derivative in nature, such as those that arise by virtue of having been married ten (10) or more years. 17. WAIVER OF RIGHTS IN OTHER'S ESTATE: Each of the parties □ waives and renounces any and all rights to inherit the estate of the other at the other’s death, or to receive any property of the other under Will executed before the effective date of this Agreement, or to claim any family allowance or probate homestead from the other’s estate, or to act as axecuter or other personal representative under a Will of the other executed befora the effective date of this Agreement, or to act as administrator, or as administrator with the Will annéxed, of the other’s estate. 18. APVISEMENTS: Each party acknowledges hereby being advised: : We Sf ay Page 11 of 24 2020-02-21 12:02 Costco W 130 sign 3236611475 >> FAXCORE P 25/38 02/21/2020 15:07:06 fig & a. To consider the immediate drafting and examination of a new Will; and b. To review all property rights and employment benefits which have a survivorship or inheritance factor (such as life insurance, pensions, inter vivos trusts, joint tenancy real . and personal property, and bank accounts); and □ To ensure that said Will and said rights and benefits accurately reflect the current desires of such party to this Agreement. 19. RESERVATION OF JURISDICTION: In the Judgment anticipated by this Agreement, there shall be reserved to the San Diego County Superior Court, in addition to the jurisdiction specifically mentioned elsewhere in this inveanant, the jurisdiction to: a. Supervise the payment of any obligation ordered paid or allocated in this Agreement. b. Supervise the division of assets as agreed to herein. ca Supervise the execution of any documents required or reasonably necessary to carry out the terms of this Agreement. d. Supervise the overall enforcement of this Agreement, 20. INCORPORATION OF AGREEMENT: This Agreement in its entirety shall be incorporated inte, made a part of, and merged into the Judgment entered in the pending dissolution of marriage — proceeding. This Agreement is not conditional upon any such incorporation, merger or filing. Husband and Wife shall submit to an order requiring that they carry out and perform each and every “provision of this Agreement on their part to be observed or Oy Sf Page 12 of 24 2020-02-21 12:03 Costco W 130 sign 3236611475 >> FAXCORE P 26/38 25:07:06 □ ® & performed. Provided that the Judgment incorporates this Agreement, the parties further agree that this proceeding may be heard on the default calendar without further notice to either party, on any — date convenient to the Court and may be heard before a pro-tem Judge. 21. WAIVERS AND JODICIAL ACTION: With regard to the Judgment that incorporates this Agreement, the parties waive statements of decision, the right to a new trial, the right to petition for a rehearing, the right te appeal, and any rights under the Seldiers □ and Sailors Civil Relief Act of 1940, as amended. 22. OTHER TERMS AND CONDITIONS : a. Successors: Except as otherwise expressly provided in this Agreement, each and cvery covenant and agreement contained herein ehall inure to the benefit of, and shall be binding on the heirs, legatees, devisees, assignees, administrators, executors and euccessors-in-interest to the parties hereto, but no provision of this Agreement shall ever be deemed or conatrued to be made for the benefit of any person other than the two (2) parties who have executed this Agreement and their respective heirs, legatees, devisees, assignees, administrators, executors and successors-in- □ interest. b. Entire Agreement: This Agreement and any other instrument(s) executed contemporaneously herewith contain the final, complete and exclusive agreement of the parties concerning the subject matters covered. Cc. Effect of Waiver: No waiver of the breach of any terms or provisions of this Agreement shall be or shall be wy ae Page 13 of 24 2020-02-21 12:03 Costco W 130 sign 3236611475 >> FAXCORE P 27/38 45:07:06 ® construed to be a waiver of any preceding or succeeding breach of . the same or any other provision hereof. d. Modification or Termination: This Agreement shall not be altered, amended, modified or terminated except by an instrument in writing executed by both Husband and Wife. Any such agreed alteration, amendment, modification or termination shall be present to the Superior Court for the County of San Diégo, California and shall be incorporated into the Judgment of Dissolution of the parties’ marriage. The parties agree that the Court shall reserve jurisdiction te incorporate such agreed alterations, amendments, modifications or terminations into the Judgment. e. No Third Party Beneficiaries: This Agreement is solely for the respective benefits of Husband and Wife. ft. Unenforceability of Part of the Agreement: Should any section, provision or portion of this Agreement be held to be invalid, illegal, veid or unenforceable, then such section, Provision or portion shall be deleted from this Agreement and it shall be read as though such invalid, illegal, void or unenforceable section, provision or portion was never included and the remainder of: this Agreement, excluding such invalid, illegal, void or unenforceable section, provision or portion, shall nevertheless subsist and continue in full force and effect. g. Applicable Law: This Agreement is entered inte in the State of California and shall be construed and interpreted under and in accordance with the laws of the State of California a ef Page 14 of 24 2020-02-21 12:03 Costco W 130 sign 3236611475 >> FAXCORE P 28/38 2026 FES07 206 hs & @ applicable to agreements made and to be wholly performed in the State of California. h. Representations: Neither of the parties hereto, nor any of his or her representatives, has made any representation or Warranty to the other party upon which the other party is relying in entering into this Agreement, except as herein expressly provided. ' i. Documents and Cooperation: (1) Each of the parties agrees on the request of the other, to execute and deliver any instrument, furnish any information and to perform any other acts reasonably necessary to carry out the provisions of this Agreement without undue delay or expense. A party who fails to comply with this subsection shall reimburse the other party for all cests and expenses, including attorney fees and court costs that, as a result of such failure, become reasonably necessary to carry out this Agreement. Upon a □ party's failure to execute a document reasonably required to carry out the provisions of this Agreement, the parties agree that the court may appoint the County Clerk, upen ex parte application with appropriate notice, as an elisor to sign such documents on behalf of the party who failed to do so voluntarily. This section shall not constitute a waiver of any privilege afforded by law. (2) The party te whom a particular asset is allocated shall pay any recording fee or transfer cost required to evidence the division of property set forth herein. ap Zot PGB E Page 15 of 24 2020-02-21 12:04 Costco W 130 sign 3236611475 >> FAXCORE P 29/38 02/21/2020,15:07:08 tt & : ® (3) For any assets divided in kind, the parties shall share any such fees and costs in the same proportions as the parties hold their interests in such assets under this Aqreement. 3. Captions and Interpretations: The captions of this Agreement are employed solely for convenience and are not to he used as an aid in interpretation. No provision of this Agreement is to be interpreted for or against either party because that party or his or her legal represantative drafted the provision. k. Enforcement of Terms of Agreement - Fees and Costs: Should it be necessary for either party to bring an action in this or any other Court for iin enbéxocnadt of any of the provisions of this Aqreement, the prevailing party in any such action shall be entitled to an award from the other party in any such action of their reasonable attorney fees and costs incurred in any such action. 23, REPRESENTATION BY COUNSEL AND KNOWLEDGE OF AGREEMENT: a. The parties acknowledge that Wife has retained David M. Huffman of the law firm of Huffman & Kostas to advise Wife in connection with the pending dissolution of marriage proceeding and with the negotiations and preparation of this Agreement. By execution of this Agreement, Husband acknowledges that he been advised by David M. Huffman ef his right to seek independent legal counsel and that David M. Huffman cannot and hag not sought to represent Husband at the same time that he is representing Wife, Husband acknowledges by executing this Agreement that he has either obtained independent legal counsel or that he specifically has chosen not to seek the advice of independent leqal counsel. Gf Page 16 of 24 2020-02-21 12:04 Costco W 130 sign 3236611475 >> FAXCORE P 30/38 02/21/2020/15:07:06 th @ @ b. Each party acknowledges and declares that he or she , respectively: (1) Is fully and completely informed as. to the facts relating to the subject matter of this Agreement, and as to the rights and liabilities of both parties; (2) Enters into this Agreement voluntarily, free from fraud, undue influence, coércion or duress of any kind; (3) Has given careful and mature thought to the making of this Agreement; and (4) Fully and completely understands each provision of this Agreement. 24. ATTORNEYS FEES: Husband shall forthwith pay Wife the sun | of $500 as and for reimbursement of Wife’s attorney's fees and eosts incurred in connection with the preparation of the pleadings associated with the pending dissolution proceeding. By execution of this Agreement, Husband acknoWledges that David M. Huffman does not represent Husband in connection with this matter even though Husband has contributed toward Wife's attorney’s fees and costs. 25. REIMBURSEMENT WAIVER: a. Except as may be specifically provided to the contrary in this Agreement, as part of the division of the community property, each party waives all rights to reimbursement for the following: (1) Epstein credits Marriage of Epstein (1979) 24 Cal. 34 76 ) and all rights to reimbursement to which a party may be entitled as a result of the payment of community obligations since the date of separation; PGB EAB Page 17 of 24 2020-02-21 12:04 Costco W 130 sign 3236611475 >> FAXCORE P 31/38 25:07:08 : ts é : (2) Watts credits (In re Marriage of Watts (1985) 171 Cal. App. 3d 366 ) and all rights to reimbursement to which a party or the community may be entitled as a result of one party’s use of community assets since the date of separation; (3) Frick credits [In Re Marriage of Frick (1986) 181 Cal.App. 3d 997 ] and all rights of reimbursement to which a party or the community may be entitled due to one party’s use of community assets for the improvement of separate property during marriage. (4) All rights to reimbursement pursuant to Family Code §2640, or otherwise, for separate property contributed to the acquisition, maintenance or improvement of community property; (5) All rights to reimbursement pursuant to Family Code §2641 or otherwise due the community or a party for contributions made by the community or either of the parties to the . education or training of a party; and, (6) All rights to reimbursement pursuant to Family Cede §915, or otherwise, due the community For payment by the community of a child or spousal support obligation of either party arising from a prior marriage or relationship. b. The reimbursement rights and claims of the parties’ have been taken into consideration in determining any equalizing “payment required by this Agreement. Therefore, these waivers constitute a part of the division of the community estate. 26. TERMINATION OF JOINT TENANCIES: Effective as soon as both parties have signed this Agreement, any and all joint tenancy ewnerships (with rights of direct survivorship) between the parties ay ef i PGB Page 18 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 32/38 02/21/2020,15:07:06 fey « & are terminated. The parties shall own those assets as tenants-incommon. This section applies to all ownerships including, but not limited to, real property, vehicles or institutional accounts. Upon execution of this Agreement and without regard to record title status, each party Waives all rights of direct survivorship from the other party. 27. REPORTING OF INCOME AND INDEMNITY: It shall be the responsibility of cach party to report all income, lesses or □ deductions (or other taxable consequences) to the taxing authorities in a Manner’ consistent with the terms of this Agreement. In the event cither party reports or fails to report income, losses or deductions (or treats the division of property) in a manner inconsistent with the terms of this Agreement, that party shall indemnify the other party for reasonable attorneys and accountants fees, and costs of litigation in defending the reporting required by this Agreement against the other party or taxing authorities. In addition, each party shall indemnify the other for taxes, interest, penalties and other assessmente arising as a result of the reporting of income (or the treating of the © division of property) in a manner inconsistent with the terms of this Agreement. This Section shall apply to all forms of tax returns required by any governmental agency. 28. TAX DOCUMENTATION: a. Each party shall forward to the other a copy of any tax deficiency notice or other correspondence or documentation received from any federal, state or local taxing authority relating to any joint returns filed by Husband and Wife. Each party agrees (oe Lag PGB Page 19 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 33/38 02/21/2020 15:07:06 Eat & & to cooperate fully with the other and to execute any document reasonably requested ‘by the other, and to furnish information and testimony with respect to any tax liability asserted by taxing authorities on any joint return. b. A party shall reimburse the other party for all damages and costs incurred as a result of a party’s failure to abide by the terms of this Section, including reasonable attorney's fees and costs, and accountant’s fees, whether incurred in defending an action by the taxing authorities or in enforcing the provisions of this Saction. . 29. LIABILITY ON PRIOR TAX RETURNS: a. Each party shall pay fifty percent (50%) of all liabilities and expenses, including but not limited to, accounting and leqal fees, relating to any tax liabilities asserted by any federal, state or local taxing authorities arising out of any review of the parties’ personal income tax returns for any period when they filed joint returns. Each party shall, however, be solely responsible for any liabilities and expenses attributalble to a party's intentional misstatement of taxable income or deductions if such intentional misstatement was not known to the other party. b. A party shall reimburse the other party for all damages and costs incurred as a result of a party’s failure to abide by the terms of this Section, including reasonable attorney fees and costs and sacckineast fees, whether incurred in defending an action by the taxing authorities or enforcing the provisions of this Section. . 9 4 : PGB B ' Page 20 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 34/38 MEAP: e 30. MUTUAL WATVER OF EXCHANGE OF FINAL DECLARATION OF DISCLOSURE, SCHEDULE OF ASGETS AND DEBTS AND INCOME AND EXPENSE DECLARATION: Husband and Wife have agreed to waive the preparation and service of final disclosure declarations including Income and Expense Declarations and Schedules of Assets and Debts. This waiver is made in accordance with the provisions of Family Coda Section 2105(c). The parties specifically acknowledge as follows: a. Both parties have complied with Family Code Section 2104 and the Preliminary Declarations of Disclosure have been completed and exchanged. b. Both parties have completed and exchanged current Income and Expense Declarations. c. This waiver is knowingly, intelligently and voluntarily entered into by each of the parties. d. Each party understands that by signing this waiver, he or she may be affecting ‘his or her ability to have the judgment set aside as provided by California law. 31. VEHICLES-HOLD HARMLESS; a. Husband and Wife shall each hold the other free and harmless from the use and operation of any vehicle confirmed or awarded to the respective party. ' b. If any claim, action or proceeding is later brought seeking te hold Wife liable on account of the future use and operation of a vehicle confirmed or awarded to Husband, Husband shall defend, indemnify and hold Wife harmless from all □ liabilities, costs and expenses relative to that claim, including attorneys fees and costs incurred by Wife in defending MH, Lah Page 21 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 35/38 — a responding to any collection claim, action or proceeding and any amounts paid by Wife in satisfaction of any judgment or other award. c. If any claim, action or proceeding is later brought seeking to hold Husband liable on account of the future use and operation of a Vehicle confirmed or awarded to Wife, Wife shall defend, indemnify and hold Husband harmless from all llabllities, - costs and expenses relative to that claim, including attorneys fees and costs incurred by Husband in defending or responding to any collection claim, action or proceeding and any amounts paid by Husband in satisfaction of any judgment to other award. Each of us has read this Agreement and is fully aware of its content and its legal effect. THE FORFGOING IS HEREBY AGREED TO BY: DATED: (9-23°7% Ch SEO. Husband,~PHILIP G. ND DATED: 7-13-*% Lisl fed , Wife, ELLEN A. ND os fab PisB EA Page 22 of 24 2020-02-21 12:06 Costco W 130 sign 3236611475 >> FAXCORE P 36/38 02/21/2020 15:07:06 STATE OF CALIFORNIA ) ) ao COUNTY OF SAN DIEGO ) : On Sune ao i998 retore Karen Yoyo —. notary public, personally appearad PHILIP G. BOND, personally to be (or proved to mo on tho basin of oatiofactory evidence) to be the person whove name is sukocrLbod to the within instrument and acknowledge to ma that he executed tha same in hin authorized capacity, and that by hia aiqnature on the inetrument the porson or the entity upon behalf of which the peroon acted, oxacuted the inotrumont. WITNESS; MY HAND OFRICIAL SEAL. ae ects taf), | j eset KAREN HAYWOOD : ( AS AL) kl if idee, Commision # 104057 htural 2 poe Pubic — aba Sa GD) Sees 4) Sat My Goren. Exploos Oct 2. 1798 stale OF CALIEDSMTA ) PE ) eo county’ oF suAreco } ; ; : On l Visitas I LWA nro Cv] lotery public, peroonally appeared E NA. BOND, personally known to be (or proved ta ma on tha ¢ basie of natLofactory evidence) to be the peraon whoaa name le gubeacribed to the within ingtrument and acknowledge to me that she executed the sama in her authorlzed capacity, and that by her signature on tho instrument the person or the entity upon behalf of which the person acted, executed the instrument. WITNESS MY HAND AND OFFICTIAI/ Jean. (olgnature) {oeal) OHATE OF new, \S COUNTY OF ney TORK E ME Neon pote, ota at Mee Vouk : Mo. 31 - 4659357 Qualifiad In New York County yv Commintion Expires Nov. 30, 199 . PGB Leb Page 23 of 24 2020-02-21 12:06 Costco W 130 sign 3236611475 >> FAXCORE P 37/38 020;75 67:08 a @ & caer tae? pgge □□□□□ oe feito ea F + □ WIFE'S ATTORNEY'S CERTIFICATION: «©. □□□ □ The undersigned hereby certifies that he isan attUrney “at law, duly licensed te practice in the ‘state of California, and he has been engaged by ELLEN A. BOND (hereinafter referred to as "Wife"), one of the parties to the foregoing Marital Settlement Agreement; that he has advised and consulted with Wife with respect to her rights and those of Husband and has fully explained to her the legal significance of the Marital Settlement Agreement: and the effect which it has upon her rights. Wife, after being fully advised by the undersigned, acknowledged to the undersiqned that - she fully understood the terms of the Marital Settlement Agreement and its legal effect, and she executed the Marital Settlement Agreement freely and voluntarily. The undersigned has no reason to - believe that Wife did not understand the terms and effects of the Marital Settlement Agreement or that she did not fraely and voluntarily execute the Agreement. No waiver of the attorney-client privilege of confidentiality is intended by this certification. parep: 7-|-4% HUFFMAN & KOSTAS By: Aan A f LDAVID M. HUF Attorneys for Wife PGB ae Page 24 of 24 2020-02-21 12:06 Costco W 130 sign 3236611475 >> FAXCORE P 38/38 02/21/2020 15:07:06 □ i om oH ah, SP sles age ees” | Fee Thx Pam Sti¢har: 2020-02-21 11:54 Costco W 130 sign 3236611475 >> FAXCORE P 3/38 02/21/2020 15:07:06 | Annuity Death Benefit Claim Form J AC K S Oo N° NATIONAL LIFE INSLIRANCR COMPANY Horne Office: Lansing, Michigan Important Instructions for Prompt Settlement www, jackson.com * Use dark ink only to complete this claim form. Print or type. * Claimant must sigh, print hame ahd date the claim form on page 7, * Include a carlified copy of the finalized death carlificate for ihe deceased with manner of passing. If the claimant is a Trustee, please provide a complete copy of the trust agreement, including all amendments and the Trust Tax Identification Number. * If the claimant is an Executor, Administrator, Guardian or other legal representative, please provide a certified copy of the court appointment. * Ifthe claimant is an Attorney-in-Fact on behalf of the beneficiary, include the Power of Attorney instrument. * any of the beneficiaries named in the Contract are deceased, please provide a copy of their death cartificaia. If the claimant |s an ex-spouse, please provide a copy of the divorce decree and proparty settlement agreement. If the claimant is a non-resident alien, please provide the W-8BEN form and Individual Taxpayer Identification Number. DECEASED INFORMATION (please print) Deceased's Name (First) (Middle) _ (Last) Other Name(s) by which Deceased was known Ht) reGoRY | Bod | □ Date of Birth (mm/dd/yy; Date of Death (mm/dd/yy Marital Status of the Deceased C2fISS//I3SE Orfeo & Sd wari [_] Divorced [7] widowed Single Social Security Number of Deceased (IMPORTANT) Contract Number(s) for which you are claiming benefits | a 2/08 | ..d0of¥essi 2 CLAIMANT INFORMATION (please print) Claimant's Name (First Middle Last Claimant's Social Security Number GREGORY | fa SOMO ages Name of Non-natural ™ Claimant (if _ Tax Identification Number Claimant's Physical Address (No P.O. Boxes) City State ZIP Code S06 SORHHOTHA LANE \|CAA YOM COLATR F/3E7 Claimant's Mailing Address Cit State ZIP Code RISE AAMTTH LAalE Enmoyel LitndTay □□□ |\P7387 Date of Birth (mm/dd/yyyy) Relationship tothe Deceased j i Ing area code) □□□ / | SOn/ Claimant's E-Mail Address ce cue cane US Citizen? 1 Yes Oo No TE ress: use [fren Do you wish to take the deceased's Required Minimum Distribution (RMD)? (| Yes [_]No + If no dollar amount is indicated, the RMD will be calculated for you, $ » Note: Please compiete Notice of Withholding on page 3. + This option may only be elected in conjunction with Options A, B, G, D or E, ne Page 1 of 8 Z1142A 03/18 2020-02-21 11:55 Costco W 130 sign 3236611475 >> FAXCORE P 4/38 Gass Seieti One of the Following Options (A, B, C, D or E), Then Sign and Date the Form. A. Lump-Sum Distribution and 5 Year Deferral Options pou seiect this option, you must alow complete the PRR TORENT ASOT ORI Hs an Choose one of the Payment Oplions below: Jackson National Life Insurance Cornpany* (Jackson") will make payment of annuity contract proceeds due you ina luinp-sum, of in increments determined by you wilhin 5 years, 1. Lump-Sum Please send mea check for my proceeds, | | Please wire my proceeds. | acknowledge Ihere will be a $20.00 wire fee and have allached a copy of a voided check. 2, 5-Year Deterral Option |_| elect to withdraw the Death Benefit within five years. | would like to withcrenv $| ___}immediatoly and understand thal | must submil the Annuity Partial or Full Liquidation [tequest, form %3101, lo withdraw the ramainder of the benetil, Please Note: this option is not available for |HAs and other qualified plans if the deceased died ufler lhe HMD beginning diate (generally April 1 after ago 70%). Note: [nh order for any wilhdrawal lo be treated as a dircel exchunge, transter or rollover, you must submit the transferring company's Lellerof Acceptance and required paporwerk, De you wish to advise us that this withdrawal will ba treated as exchange, transter or rollover? [] Yes B, spousal Continuation Option = i you sefect thie option, you mest aie completo Soction F, “Hermficlary Designation.” As the spouse of the deceased, | elect to continue the Contract in my name. Note: It you choose this option you de nat need to ratum Ine Contract lo Jackson If he contract hus the IncomeAccelerator Lifetime Income Beneiit (LIB), iL will lerminate automatically upon election of ie Spousal Continuation Oplion unless you are a covered lite under the LIB with joint option. If you are a covered life under the 116 wilh joint option, he LIB with joint option will remain in effect upon continuation of lhe Contract and may be lerminated independently from the Contract to which It is attached only as allowed by the Termination of the | 1B provigion, it you are coyered under Ihe LIB with joint option, you may set or change the activation date by submilling a completed Activation Forn (44391). Please see Important Information on page 8 for more information regarding the ability to sel, change or cancel the Activation Date, If the contract has the Lite?ay Lifetime Income Rider (LIA), you may clect le tenninate the 1A benctit upon election of ihe Spousal Continuation Option. It you elect fo terminate the LIR, a pro rata LIN Charge will be assessed tor Ihe period since Ihe previous Indexed Option Anniversary, applicable charges will be stopped thereafter and no beretfil will be available. If no lection is mada on the continuation dale, the 1/7 will remain in effect and may be subsequently terminated independently tren the Contract to which it is attached only as allowed by the Termination of tho LIK provision. If you area covered life under the joint benefit, the folnl LIB remain in ettect and may be subsequently lenninaled independontly trom the Gonlract to which it is altached only as allowed by the Tennination of the 11H provision. | elect to continue the LIA. |_|! elect to terminate LIA Page 2 of 8 211424 03/18 2020-02-21 11:55 Costco W 130 sign 3236611475 >> FAXCORE P 5/38 (02/21/2020 15:07:06 _ G Systematic Withdrawal Option = If you welvel this option, you mus! alse complete the “Notico of Withholding” section on page J and Section F, “Bovoficlary Designation.” To authorize direct deposit into your checking or savings uccount, please complete the “Direct Dopoait” section on page 5. If you sefect on Irrevocuale Spstamatic Withdrawal (SW) of Strefch IRA option, no lidexed options will be ovullabte fo pou {if currently opplicadto), und interes! will be credited af o rate bowed on the current and guanonteed Infereat rates duckson credits on fixed anneety colfructs i eurrantiy offers; thet miterest rute moy be heen than tie rofes duckwon oredite fo the Pixie or Fixed Indexed Amnulty. Leslie! a | choose fo take disiribulions over my life expectaniy using Ihe following option: IRA: | choose lo lake distributions over my life expectancy (STRETCH IRA). While you mustlake a minimum amount each year lo salisly IAS requiraments, actditional amounts may be taken al any lime. IF elacted, you may name a beneficiary. If you were to die prior lo recelving all payments, your Duneficiary(ies) may continue any such distributions or lake the current Contract Value as a lump-sum diztnbution. (This option may not be available on all products.) | ]Non-Qualified Annuily:| chouse to take distributions over my life expectancy (ISW). While you must take a minimum arnount cach year lo sulisfy (RS requirements, addilional amounts may ba taken al any time. If clected, you tay name a beneficiary. IF you die prior to receiving all payments, your beneficiary must take the current Contract Value as a lump-sum distribullon, (This option may not be available on all products.) | Spousal Stretch Deferral: | elect lo defar stretch payments at this lime. | understand in the tulure: | must contact the Service Center for tulure distributions. Please select a Mode: |_|Monthly |_| Quarterly [| ]Semi-Annually |_|] Annually Process the first payment as of (mmidd/yyyy) | _| (Calendar days 29, JU, and 31 are not allowed.) □□□ initia! payment date fs nol Inci¢aled, the first payment will begin 30 days afler this form is received by the Claims Scrvive Genler, Notice of With holding — ifyou hove selected opiien A or G, or if you have requested fo lake the deceased's AMD, you must complete this soction, ne Note: Taxes will be withheld if no election is made. Federal Tax Withholding The taxable portion of the distribution made to you will be subject fo 10% (20% for eligible rollover distributions") federal income tax withholding unlass you elect not to have wilhholding apply. po nol withhold federal income tax from my distribution. (lf this box is checked, du nol check box 4 or 3 below.) This option is not avallable tor an eligible rollover distribution trom 403(b) contracts, If you elect not to have wilhhelding apply to your wilhdrawals, or it you de nul have enough withheld, you may be responsible for payment of eslimaled tax. You may incur penallics under ihe eslimaled fax rules If your withholding and estimated tax payinenis are not sufficient 2.| | Withhold 10% (20% for eligible rollover distributions") federal income tax from my distribution. In addition ty the instructions in No. 2 above, please wilhhald the following additional percentage:| | “io State Tax Withholding (Depending on the laws in your state, stale income tax withholding may be required, See "Important Information” section on payy 8 for slate withholding requirements.) _ 4.|_|“Yes,” please withhold the following percentage tor stale income taxes: | |. 5..y')"No," do net withheld slate incume lax. “atl ale pollowee diotributlon fa ony distribution of ull ca ey portion of the balance to the credit of the Owner, Howover, such ofigible rollover usirlbution not inciude: (1) any dritabulyn That i one of a sores of aubatontiolly eyiel padlodic puyments (nothess frequently than annually) ppacte for the fife (or life expectancy) ul ihe Owner of tho joint invos (or joint lite exqpectanuws) of te Quiet ened the Owner's beneticiay, a ture apecilied parlod of tan (10) yours or more, (2) cory dniindyybon iepaire uiie Code Soction [oye (2) any hordehip dratritaullon, end (4) ine portion of tiny dish tution Waal i not included In groga mon, Paga 3al 8 21142A 03/18 2020-02-21 11:55 Costco W 130 sign 3236611475 >> FAXCORE P 6/38 TeO7.0e D. Benefit Continuation Option — □ □□□ scteet this option, you must also complete tho "Notice of Withholding” seation on page 6 and Section F, “Beneficiary Designation.” Ta authorize direct dopoalt Into your checking or savings account, please complete the “Dircot Deposit" section on page 5. sit elect to continue the periodic benefit checks the Annuitant was receiving, E. Income Option Election (Monthly Genetit Must Ge $50 or More.) — if you aeicet one of these options, you must also complete the “Notice of Withholding” section on page & and Secilen F, “Benoficiary Designation.” To authorize direct deposit Inte your checking or savings account, please complete the “Direct Deposit” section on page 5. If an illustration is desired, please contact our office. Income Option A— (Life Only) Equa! payment will be mace to the annuitant as long as he or she is living. Benefits cease al the death of the annuitant, Thera Is no tight to select lump-sum payments for the annuitant and/or owner, Income Option B— (Lite, a - Year Certain) Aterm of ten (10) or 20 years is available. However, a period-cartain may not axtand beyond the life expectancy of the annuitant, Equal payments will be made to the annuilant as long as he or she is living, DEATH BENEFIT: If the annuitant were to die prior to receiving the period-certain payments, any such unpaid payments shall be continued to the designated beneficiary, There is no right to select lump-sum payments for the annuitant and/or owner. [_| Income Option C— (| i Year Term Certain) A period of five through 60 years is available. However, a period-certain may not extend beyond the life expectancy of the annuitant, Equal payments will be made to the annuitant for the specified period of years. DEATH BENEFIT: If the annuitant were to die prior to having received all payments due under this Contract, payments shall be continued for the balance of the period to the beneficiary designated. There is no right to select lump-sum payments for the annuitant and/or owner. “Please send proof of age: either a copy of your birth ceriificats or a copy of your driver's license (or other identification provided by the stale). Benefits will commence upon receipt ol this paperwork in goad order. Frequency of benefit payments: [_] Monthly Quarterly [|] Semi-Annually [__| Annually Page 4.of a 211424 03/18 se a al 2020-02-21 11:56 Costco W 130 sign 3236611475 >> FAXCORE P 7/38 (02/21/2020 15:07:06 | Direct Deposit ~ it you eolected option ©, D, or E, you may authorize diroct doposit by completing this section. | hereby authorize Jackson to direct deposit into lhe chucking or savings account identitied below, until further notice, all contract payments due to the owner of the contract, If the contract Is owned by a irust, [| affirm that | am the current Irustee of the trust and am authorized to make (his request on behalf of the trust, [his authorizalion will remain in eftect until it is revoked in writing, | andor the (rust hareby release and agree to indemnify and hold Jackson harnluss fran any and all claims arising out of or in any way relailed lo Jackson's actions in cormpliance wilh (his aulhorization, | agree thal Jackson Will have no further lability with respect to any payments meade in accordance with this aulhorizalion and may, at any lime, discontinue my direct depusil and Issue checks lo me requiring my personal endorsement. |, for myself, my heirs, execulurs, administrators, and assigns, do heraby consent and agree that any sums of maney cdoposiled lo my account after my dealh shall be refunded to Jackson for distribution to the person or persons, if any, enhiled to those sums under the terms of the contract. (checking Account (tape pre-printed volded check below) * Savings Account (provide letter trom bunk on institution's letterhead; letter must bo signed and dated by a bank representative) * * Direct Deposit will nol be established without receipt of a pre-printed voided check or lettar from your bank. Please nole: Contract payments will gonerata on the day thay are due or the next business day and will be dapasited inte your account within 2-3 business days (racoipl of funds mny bo dolayed by a weekend ur holiday). All paymonts trom custodian owned contracts will be mado payablo tothe Custodian for both dirua duposils and checks. Do not slaple, Do not allach a deposit slip or a starter check. Account Holdor's Mame(a) 245 Main St, Anywhere, USA G0000 Poy To The Order OF — $| _.. et ioollats Your Financial Institutian Vol D Address ———————_State, ZIP 2a Your Transl! fouling Number Your Account Number Your chock umber Payy 5 of 8 Z1142A 03/18 2020-02-21 11:56 Costco W 130 sign 3236611475 >> FAXCORE P 8/38 (02/21/2020-15:07206 Notice of Withholding = i you have sctected option D or E, then you must complete this section. Annuity payments from income options are treated as wages for the purpose of income tax withholding. An annuity payment is one that is included in your income for tax purposes and that you receive in installments at regular intervals over a period of more than one full year from the starting date of the particular investment. The intervals can be annually, semi-annually, quarterly, or monthly. you tell Jackson otherwise, tax must be withheld on annuily payments as if you are married and claiming three withholding allowances, For ahhuity payments, your withholding certificate stays in effect until you changa or revoke it. Jackson must notify you each year of your tight to elect to have no tax withheld or to reveke your election. if you elect not to have withholding apply to your withdrawals, or if you de not have enough withheld, you may be respensible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withhalding and estimated tax payments are not sufficient. Complete the following applicabie lines: You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your payments. {elect notto have state and federal income tax withheld from my pension or annuity. elect withholding from each perlodic pension or annuity payment to be figured using the number of allowances and marital status shown (you may also designate an amount In the box at the right). Number of allowances:| Marital Status: [|Single [_|Maried [_|Martied, but withholding at higher single rate. J i elect the following additional amount withheld from each pension or annuity payment. Notes For annuity payments, you cannot enter an amount here without entering the number (including zero) of allowances above, § | your state of residence has state Income tax, you may elect to have taxes withheld using the same allowances and _ marital status as used for federal withholding. [] | elect to have state tax withheld, (Depending on the laws in Your state, state income tax withholding may be required. See "Important information’ section on page § for state withholding requirements.) F, Beneficiary Designation — if you have selected option A, 3, C, D or E, then you must complete this section, Please name your beneficiary(ies), For additional banaficiarias, plaage attach additional namefs) and requested information on a separate sheet, signed and dated, Primary Yio) Percentage of Death Benefit Name (Firat {Nilecte) {last} ss Date of Birth {mnvagyyyy) ia ser le Lay dod fier ll 72 Entty Name ~~ Tax [dentilication Number Fialallonship to You (nunber, street) Ghy State ZIP Coda Phons Number (includa area coca) actetnerte tiné, \CAuvodcoured ete || M327 _( Page 6 of 8 Z11424 03/18 2020-02-21 11:56 Costco W 130 sign 3236611475 >> FAXCORE P 9/38 (02/21/2020 15:07:06 | 2. {Primary [_] Contingent [ | Percantage of Death Benefit Benonclary’ Namo (Fist) (Mibdig} | Sockygecwty Norbord Non-Matural Entity Marre Tax (dontlication Number aa (number, street) sr State ZIP Coda Phone Nunbor aaroa □□□□ I ia 3, [_]Primary [| Contingent | Percentage of Death Benefit _ | —_e__ Non-Nahural Emiky Mame Tax: idontiflcatiges Number Falationghip io vou | LC] hy ara JF Code Note: All Primary Beneficiary percentages must be in whole percentage numbers that total 100%. All Contingent Beneliciary percentages must also be in whole percentage numbers that total 100%. Ifno beneficiary is elected, your Estate will be recorded, Signature(s) The undersigned hereby makes claim to the undersigned’s share of the death benefit proceeds of he above annully Contract as beneficiary and agrees that the furnishing of this form or any of the forms supplemental thereto by the Company shall not constitute or be considered an admission by the Company thal there was an annuity in force, nor shall it constitute or be considered a waiver of any of the Company's rights or defenses, THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR GONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING. Under penalties of perjury, | certify that: 1. The number shown on this form is my correct Taxpayer Identification Number, 2. | am not subject to backup withholding. 3. | am a U.S. citizen or other U.S, person {including a U.S. resident alien). 4. lam exempt from Foreign Account Tax Compliance Act (FATCA) reporting. By signing balow | acknowledge | have read all options available to me. Please note; ALL ELECTIONS ARE IRREVOCABLE, YOU MAY WISH TO CONTACT A TAX ADVISOR. , New Jersey residents, please note: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Chimant’s Dare mvddyy) Claimants Name (First) (Mode) Ay FA oxfefaso|| crsoer |7> uo (hare ef WW Ereases Gute Sioned (mewayy Wane Makara [Mkicio) sigan ey : “ ee Ueex() Eo Naf lume |e. Boo Page 7 ol 8 21142A 03/18 O_O 2020-02-21 11:57 Costco W 130 sign 3236611475 >> FAXCORE P 10/38 eee epg Important Information - Please Read Carefully eee □□□ en + The entire death banefil mus! be paid within fiva (6) years of the date of death unless you elect to have the death benefit payable under an Income Option or the Systematic Withdrawal Option. The death benefit payable under an Income Option or the Systematic Withdrawal Option must be paid over your lifetime or for a period not extending beyond your life expectancy. + For non-qualified funds, the first IAS-required wilhdrawal under the [SW and Income Option must occur within twelve months of {he owner's death. For Lump-Surm Distributions, non-qualified funds must be completely withdrawn by the fifth anniversary of the date of death, + For qualified funds, the first |R'S-required withdrawal for the Stretch IRA and Income Option must occur by December 31st of the year following the owner's death, For lump-sum distributions qualified funds must be completely withdrawn by December 31 following the fifth anniversary of tha date of death. « If you wish to elect an Income Option or the Systematic Withdrawal Option you must do so within the 60-day period beginning with the date Jackson receives proof of death. Please note: with these options your beneticiary will not receive any enhanced death benefil protections. = Continuation Option is selected fora JNL Target Select * contract, the original allocation period will remain in effect. The Beneficiary will have the option to select a new allocallon perlod upon renewal. + Ploase note: the following states do not have state Income tax. We are not allowed to withhold state tax for these slates: Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington and Wyoming. The following states allow you to elect out of state withholding: California, Delaware, Oregon and Vermont. The state of Georgia allows you to elect out of slafe withholding on benefit payments only. Please note: if you are a Michigan resident, we may be required to withhold state tax al the prevailing fixed percentage. » If you elect to have federal withholding, we are required to withhold for state purposes at the prevailing fixed percentage of the federal rate for the following slates: Arkansas, California, Delaware, Georgia, lowa, Maine, Massachusetts, Mississippi, Nebraska, North Carolina, Oklahoma, Oregon, Vermont and Virginia, + The 10% premature distribution penalty does not apply to distributions made to the beneficiary on or after the death of the original holder of the Contract. + Remember that there are penalties for not paying enough lax during the year, either through withholding or estimated lax payments, New retirees, especially, should see IRS Publication 505, Tax Withholding and Estimated Tax, which can be obtained by contacting the IRS. Publication 505 explains the estimated tax requirements and penalties in detail. You may be able fo avoid quarterly estimated lax payments by having enough tax withheld from your payments, * Please note: if you continue a Contract with a LIB, you may sel or change the Activation Date by completing the Activation Request Form (X4391). lf an Activation Date has been set, you may change or cancel that date by notifying the Company at least 30 days prior to the selected Activation Date. If you do not notify the Company at least 30 days prior to the Activation Date, it cannot be changed or canceled, Mailing Address and Contact Information Jackson Clabns Administration Fegatar ie Overnight Mall 1 Corporate Way, Lansing, MI 48051 Customer Care 836-505-4995 (M-Th: €:00 am. to #00 p.m. ET ond Fri: 8:00 a.m, to 6:00 p.m. ET) Fax* 617-T08-S613 sia ee Gustomercare @pckacn cote a * A lax cover page is not needed. If you have additional instructions to submit please complete Letter of Ingtrection (lorm X4250) including owner and/or annuitant signature(s) 83 applicable, Paga 8 ol 8 211424 03/18 JACKSQN NATIONAL LIFE INSURANCE COMPANY Claims Administration March 14, 2020 Gregory Bond 29506 N Mammoth Lane Canyon Country, CA 91387 Deceased: Philip G Bond Policy No.: 0004865310 Dear Gregory Bond: We are sorry to hear about the death of Philip G Bond and wish to extend our condolences. Based on the information provided, we have established a claim for the following: Policy Number Named Beneficiary Preselected Benefit Option 0004865310 Ellen A Bond Please be aware that it is very important that you provide us with the contact information for the beneficiary(ies) listed above. If this information is not received, it may delay our processing of the claim. In addition, unclaimed funds will be reported to the state as required by law. Please be advised that any scheduled distributions will cease and any un-cashed payments, issued in the deceased's name, have been stopped. In order to process the claim promptly, please return to us the following: * Claim Form * Final Certified Death Certificate Once we receive this information, we will process the claim as quickly as possible. Please be advised, any documentation submitted to our office will not be returned. The State of California Department of Insurance requires that our Company advise you that if you wish to take this matter up with the California Department of Insurance, the telephone numbers for the consumers hotline are 1/800-927-HELP or 213/897-8921. You may write to the California Department of Insurance, Claims Service Bureau at 300 South Spring Street, 11th Floor, Los Angeles, CA, 90013. Jackson National Life Insurance Compan | Corporate Way, Lansing, MI 48951 800/644-4565 Policy Number: 00048653 10 | □ March 14, 2020 If you have any questions or need additional information, please contact our Service Center toll free at 888/565-4995. Sincerely, Muto. Nornoor Laura Hanson VP, Policy Owner Services Enclosure: Claim Form Ji\n LIFE INSURANCE COMPANY 1 Corporate Way Lansing, MI 48954 May 4, 2020 Ellen A. Ifshin 25 Parkview Ave Apt 3K Bronxville NY 10708-2917 Sent via Certified and First-Class Mail RE: Contract Number: 0004865310 Annuitant: Philip G. Bond (deceased) Owner: Focus 2000 Dear Ellen A. Ifshin: : Please accept our sincerest condolences on the death of Philip Bond. We would like you to know that we are available for any questions you may have. At his death, Philip Bond was the annuitant of an annuity issued by Jackson National Life Insurance Company (“Jackson”). A review of our records shows that you remain the recorded beneficiary of the annuity. As of May 4, 2020, the value of the annuity’s death benefit proceeds is $15,174.16. Jackson has received a claim from the annuity’s contingent beneficiary. To proceed with our claim handling, we must know your intentions regarding the annuity. Please tell us by June 1, 2020, whether you intend to claim the annuity’s death benefit proceeds or whether you waive your claim to the annuity’s death benefit proceeds. If you waive your claim to the annuity’s death benefit proceeds, Jackson will pay the proceeds to the contingent beneficiary. You may notify us of your intentions by either (1) calling our Service Center at 888/565-4995, or (2) responding to this letter by completing the below “ELECTION REGARDING CLAIM FOR PROCEEDS?” and returning this letter to Jackson in the enclosed pre-addressed, postage-paid envelope by May 29, 2020. Please keep a copy of the letter with your election marked, Note: if you do not respond to this letter or Jackson receives competing claims to the annuity’s death benefit proceeds, Jackson may be unable to distribute the death benefit proceeds until that dispute is resolved. If you need extra time to make your election, promptly let us know by calling us at 888/5654995. If you have questions about your legal rights, or need legal advice, we recommend you immediately consult a licensed attorney. Variable Products issued by Jackson National Life Insurance Company® and distributed by Jackson National Life Distributors LLC, member NASD. 800/565-8797 Your service needs are very important to us. If you have additional questions or concerns, please contact our Service Center at 888/565-4995, Monday through Thursday, 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. to 6:00 p.m. (ET). You may also contact Jackson via email through “Contact Us” on our website at www.jackson.com. Sincerely, Laura Hanson, VP Policy Owner Services ELECTION REGARDING CLAIM FOR PROCEEDS Please mark the appropriate box, sign and date, and return this letter to Jackson in the enclosed pre-addressed, postage-paid envelope by June 1, 2020. I, Ellen A. [fshin: [] CLAIM that I am the proper beneficiary of Philip Bond’s Jackson annuity and I intend to file a claim for the annuity’s death benefit proceeds. L] WAIVE all claim to Philip Bond’s Jackson annuity and consent to Jackson’s payment of the annuity’s death benefit proceeds to the annuity’s contingent beneficiary. Signature Printed Name Date May 4, 2020 □□□ ee titi GREGORY T. BOND 29506 MAMMOTH LANE CANYON COUNTRY CA 91387 RE: Contract Number 0004865310 Annuitant: Philip G. Bond, Deceased To Whom It May Concern: Thank you for submitting Philip Bond’s divorce documents for our review. As you know, Ellen Bond was the annuity’s primary beneficiary at the time of Philip Bond’s passing. Our Legal Department has reviewed the divorce documents you submitted, and it is our opinion that Philip Bond’s divorce from the primary beneficiary did not automatically revoke her designation as beneficiary of the annuity. We ask that you notify us if you disagree with our opinion. We believe that we have located the primary beneficiary using her name supplied in the divorce documents and we are reaching out to her to determine whether she intends to make claim to the annuity’s death benefit proceeds. As of May 4, 2020, the value of the annuity’s death benefit proceeds is $15,174.16. We have asked her to provide us with confirmation of her intent by June 1, 2020, and we will notify you after we receive that confirmation. If Jackson receives competing claims, we may not be able to distribute the death benefit until that dispute is resolved. If you have any additional questions or concerns, visit our website at www.jackson.com to contact Jackson via email or for additional resources. You may also contact our Service Center at 888/565-4995. Sincerely, Cf? Kh, Sonve HMerpsen Laura Hanson, VP Policy Owner Services Contact us: Visit www jackson.com @ 1-800/644-4565 * 24-hour automated service; Service Associates available Monday thru Friday 05/16/2020 09:05:23 | 05/16/2020 09:05:23 Box DCC14044 057980 36 Your service needs are very important to us. [fF you have additional questions or concerns, please contact our Service Center at 888/565-4995, Monday through Thursday, 8:00 a.m. to 7:00 pam. and Friday 8:00 am. to 6:00 p.m. (ET). You may also contact Jackson via email through “Contact Us” on our website at www. jackson.com. Sincerely, Laura Hanson, VP Policy Owner Services ELECTION REGARDING CLAIM FOR PROCEEDS Please mark the appropriate box, sign and date, and return this letter to Jackson in the enclosed pre-addressed. postage-paid envelope by June 1. 20230, I, Ellen A. [fshin: i CLAIM that | am the proper beneficiary of Philip Bond's Jackson annuity and I intend to file a claim for the annuity’s death benefit proceeds. LC] WAIVE all claim to Philip Bond's Jackson annuity and consent to Jackson’s payment of the annuity’s death benefit proceeds to the annuity’s contingent beneficiary. Sten Signature ELLEN A. LESHEN Printed Name _ MAY UM, FORO Date 2020-05-12 10:12 Costco W 130 sign 3236611475 >> FAXCORE P 1/2 05/12/2020 13:12:39 To: Jackson National Life Insurance (Via Fax and Return Mail) Date: May 12, 2020 Re: Policy #0004865310, Philip G. Bond (Annuitant) From: Gregory T. Bond 29506 Mammoth Lane Canyon Country, CA 91387 My name is Gregory T Bond and | am writing to notify you that | disagree with your letter of May 4, 2020 wherein you state that the divorce documents do not automatically revoke Ellen Bond as the primary beneficiary of the above listed annuity. In the event Ellen Bond chooses to attempt to claim this annuity | am specifically contesting that claim. Your letter states that you have given Ellen Bond until June 1, 2020 to stipulate whether she is going to/not going to make an effort to claim this annuity. | would appreciate being notified ifwhen that happens and/or if/when that does not happen. Thank you, Koo Bond Attachment: Jackson National Letter of May 4, 2020 a VE DSU 2O2G 55:19 BOX DCCI4062 058168 2 Annuity Death Benefit Claim Form J AC K S od N? NATIONAL LIFE INSURANCE COMPANY : Home Office: Lansing, Michigan Important instructions for Prompt Settlement www, jacksen,com * Use dark ink only to complete this claim form. Print of type. Claimant must sign, print name and date the claim form on page 7. * Include a certified copy of the finalized death certificate for ihe deceased with manner of passing. * the claimant is a Trustee, please provide a complete copy of the trust agreement, including all amendments and the Trust Tax Identification Number. * If the claimant is an Executor, Administrator, Guardian or ciher legal representative, please provide a certified copy of the court appointment. claimant is an Allorney-in-Fact on behaif of the beneficiary. include the Power of Aftorney instrument. * If any of the beneficiaries named in ihe Contract are deceased, please provide a copy of their death certificate. * If ihe claimant is an ex-spouse, please provide 4 copy of the divorce decree and property seitlement agreement. * ihe claimant is a non-resident alien, please provide the W-3BEN form and Individual Taxpayer Identification Number. DECEASED INFORMATION (please print) Deceased's Name (First) (Middle) (Last) ____ Other Name(s) by which Deceased! was known | Peer (Grecory | BoND Date of Birth (mm/ddfyyyy) _ Date of Death (mm/dd/yyyy) Marital Status of the Deceased io 1S | [ (4 3 Oo oO} fo [der & | YZ Married [ | Divorced [ ]Widowed [| Single Social Security Number of Deceased (IMPORTANT) Contract Number(s) for which you are claiming benefiis | 1. |COOY SES S10 2 | CLAIMANT INFORMATION (please print) Eleimant’s Name (First) (Middle} (Last) — i io! Security Number [eeeexn | Ae gee] Name of Non-natural Entity Claimant (if applicable) □ ___ Tax Identification Number _ Claimant's Physical Address (No P.O. Boxes) City _ __ State ZIP Code } Paawview Ave || BRowxvinte wy lL toes _| Claimant's Mailing Address Gily Static ZIP Gode i APT Bid Date of Birth (mmidd/yyyy) Retationship io the Deceased Daytime Phone Number (including areaccde) hate | ewe eee eT a a eg I po oss Glaimant's E-Mail Address US Cilizen? (Myes Bo you wish to take the deceased's Required Minimum Distribution (RMD)? Nd ves i | No «lf no collar amount is indicated, the RMD will be calculated for you. $ | «Note: Please complete Notice of Withholding on page 3. — « This option may only be elected in conjunction with Options A, B, C, Dor E. Page 1 of 8 21142 03/18 06/01/2020 07:55:19 | Please Select One of the Following Options (A, B, C, D or E), Then Sign and Date the Form. A. Lump-Sum Distribution, Beneficiary Access Account and 5-Year Deferral Options —ir you seiecr this option, you must also complete the “Notice of Withholding” section on page 3. Choose one of the Payment Options Below: (If no settlement option is selected, Jackson National Life Insurance Company * (Jackson®) will contact the beneficiary to seek an affinative selection from the beneficiary.) 1.,Lymp-Sum x Please send me a check for my proceeds. | | Please wire my proceeds. | acknowledge there will be a $20.00 wire fee and have allached a copy of a voided check, 2. Beneficiary Access Account (BAA) | | Please establish an interest bearing BAA in my name for my proceeds and send me a book of checks for access to my money. 3. 5-Year Deferral Option ———— | elect to withdraw the Death Benefit within five years. | would like to withdraw $| | immediately and understand that | must submil the Annuity Partial or Full Liquidation Request, form 43701, to withdraw ihe remainder of the benefit. Please Note: this option is not available for IRAs and other qualified plans if Ihe deceased died afler the RMD beginning date (generally April 1 after age 7O¥2.) Jackson will make payment of annuily contrac! proceeds due you in a lump-sum. Except when contract proceeds are due corporations, partnerships, trusts, estates, minors, and beneficiaries resident in the slate of New York, if the proceeds due you are $5,000 or grealer, you may request {above} thal Jackson establish a BAA in your name thal permits you to write checks to withdraw your money from Ihe BAA. Money in a BAA remains ina Jackson general account until withdrawal. Jackson will pay you inlerest on money in your BAA. Your BAA will not be FDIC-insured. Note: In order for any withdrawal to be treated as a direct exchange, tranafer or rollover, you must submit the transferring company's Leiter of Acceptance and required paperwork. Do you wish to advise us that this wilhdrawal will be treated as a direct exchange, transteror rollover? | | Yes B. Spousal Continuation Option = iryou select this option, you must also complete Section F, “Beneficiary Designation. |] As the spouse of the deceased, | elect to continue the Contract in my name. Note: If you choose this option you do not need to return the Contract to Jackson. If ihe contract has the IncomeAccelerator Lifetime Income Benefit (LIB), it will terminate automatically upon election of {he Spousal Continuation Oplion unless you are a covered life under the LIB with joint option. If you aré a covered life under the LIB with joint option, the LIB with joint option will remain In effect upon continuation of the Contract and may be terminated independently from the Contract to which itis allached only as allowed by the Termination of the LIB provision. If you are a covered life under the LIB with joint option, you may set or change the activation date by submitting a completed Aciivation Form (X4391). Please see Important Information on page 8 for more information regarding the ability to set, change or cancel the Activation Date. lf the contract has the LifePay Lifetime Income Rider (LIF) you may elect to terminate the LIR benefit upon election of the Spousal Continuation Oplion. If you elect to terminate the LIR, a pro rata LIR Charge will be assessed for the period since the previous Indexed Oplion Anniversary, applicable charges will ba stopped therealter and no benefit will be available. |f no election Is made on the continuation date, the LIF will ramain in effect and may be subsequently terminated independently from the Contract to which it is allached only as allowed by the Termination of the LIA provision. If you are a covered life under the joint benetii, the joint LIR remain in effect and may be subsequently terminated independently from the Contract to which il is allached only as allowed by the Termination of the LIF provision, [|| elect to continue the LIR. elect to terminate LIR. Page 2 of 8 21142 03/18 06/01/2020 07:55:19 | oie Lie Hiak fic wit i A Orawan We TO pir 6 A =f you select this option, you must also complete the “Notice af Withholding* section on page 3 and Section F, “Beneficiary Designation.” To authorize direst deposit into your checking or savings account, please complete the “Direct Deposil® section on page 5. if you select an Inevocable Systematic Withdrawal (SW) or Stretch (FA option, no indexed options will be available to you (if currently applicable), and interest will be credited at arate based on the current and guaranteed interes! rates Jackson credils on fixed annuily contracts I. currently offers; that interes! rate may be fess thon ihe rates Jackson credits fo the Fixed or Fixed indexed Annuity. | choose to take distributions over my life expectancy using the following option: IRA; | choose to take distributions over my life expectancy (STRETCH IRA). While you must take a minimum amount each year to satisty IRS requirements, additional amounts may be taken al any time. If elected, you may name a beneficiary. If you were to die prior to receiving all payments, your beneficiary(ies) may continue any such distributions or take ihe current Contract Value as a lump-sum distribution. (This option may not be available on all products.) [| Non-Qualified Annuity: | choose to take distributions over my life expectancy (ISW). While you must take a minimum amount each year to satisfy IRS raquirements, additional amounts may be taken at any time. If elected, you may name a beneficiary. If you die prior to receiving all payments, your beneficiary must take the current Contract Value as a lump-sum distribution. (This option may not be available on all products.) |_| IRA Spousal Stretch Deferral: | elect to defer strech payments at this time. | understand in the future | must contact the Service Center for future distributions, Please select a Mode: [_|Monthly [ |Quarterly [_]Semi-Annually [_] Annually Process the frst payment as of (mmudcyyyy)| ————_—|. (Calendar days 29, 30, and 31 are not allowed.) If an initial payment date is not indicated, ihe first payment will begin 30 days after this form is received by the Claims Service Center, Notice of Withholding — iyou have selected option A or , or if you have requested fo take the deceased's RMD, you must complete this section. Note: Taxes will be withheld if no election is made, Federal Tax Withholding The taxable portion of the distribution made to you will be subject to 10% (20% for eligible rollover distributions") fecleral income tax withholding unless you elect not to have wilhholding apply. 1. Do not withhold federal income tax from my distribution. (If this box is checked, do nol check box 2 or 3 below.) This option is not available for an eligible rollover distribution from 403(b) contracts. If you elect not to have withholding apply to your wilhdrawals, or if you do not have enough withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. weno 10% (20% for eligible rollover distributions") federal income tax from my distribution, 3. | In addilion to the insiructions in No. 2 above, please withhold the following additional percentage: | State Tax Withholding (Depending on the laws in your stale, slate income tax withholding may be required. See “Important Information” section on page 8 for slate withholding requirements.) aX|"ves," please withhold the following percentage for state income taxes:| 5 5. "No," do not withhold stale income tax, “An eligible rollover distribution is any distribution of all or any postion of the balance to the credit of tha Owner, However, such eligible rollover distribution does not inchide: (7) any distribution thatis one of 2 sacins of substantially equal periodic payments (not lees frequanily than annually) made for the life (or We expectancy) of the Owner or tivo joint lives (or joint lifa expectancies) of the Qwnet and the Quiier's beneiiciasy, or for a speciiod period of tan (10) of more; (2) any cistibution required undar Goda Section 401(a)(9); (3) any hardship cisiritution; and (4) the portion of any distribution thatis not included iin gross income. Page 3 of 8 21142 03/18 (06/01/2020 07:55:19 D. Benefit Continuation Option — i you select thie option, you must also complete the "Notice of Withholding” section on page Gand Section F, “Beneficiary Oesignation.” To aulhorize direct deposit into your checking or savings account, please complete the “Direct Ooposit™ section on pages. | elect to continue the periodic benefit checks the Annuitant was receiving. E. Income Option Election (monthly Benetit Must Be $50 or More.) — i you select one of these options, you must also complete the “Nofice of Withholding" section on page 6 and Section F, “Beneficiary Designation.” To authorize direct deposit inlo your checking or savings account, please complete the "Direct Deposit" section on page 5. If an illustration is clesired, please contact our office. ** Income Option A—(Life Only) Equal payment will be made to the annuilant as long as he or she Is living. Benefits cease al Ihe death of the annuitant. There is no right to select lump-sum payments for the annuitant and/or owner. | Income Option B— (Life,| - Year Certain) Aterm of ten (10) or 20 years is available. However, a period-certain may not extend beyond the life expectancy of the annuitant, Equal payments will be made to the annuitant as long as he or she is living. DEATH BENEFIT: If the annuitant were to die prior to receiving the period-certain payments, any such unpaid payments shall be continued fo the designated beneficiary. There is no right to select lump-sum payments for the annuitant and/or owner. [_|Income Option c—(| - Year Term Certain) A period of five through 60 years is available. However, a period-cerlain may nol extend beyond the life expectancy of tha annuilant. Equal payments will be made to the annuitant for lhe specified period of years. DEATH BENEFIT: If the annuitant were to die prior to having received all payments due under this Contract, payments shall be continued for ihe balance of the period to the beneficiary designated, There is no righl to select lump-sum payments for the annuitant and/or owner, **Plaase send proal of age: either a copy of your birth cerliticate or a copy of your driver's license (or other identification provided by the state). Benefits will commence upon receipt of this paperwork In good order. Frequency of benefit payments: [ | Monthly Quarterly [_]Semi-Annually | | Annually Page 4of8 21142 03/18 ssa esses seen ee eee eee EEL □□□ □□ 06/01/2020 07:55:19 | Rece OR ULC R210 Bow 058168 Notice of Withholdi NQ = if you have selected option D or E, then you must complete this section. Annuity payments from income options are ireated as wages for the purpose of income tax withholding. An annuity payment is one that is included in your income for tax purposes and that you receive in instalments at regular intervals over a period of more than one full year from the slarting date of the particular investment. The intervals can be annually, semi-annually, quarierly, or monthly. Unless you tell Jackson otherwise, lax must be withheld on annuity payments as if you are married and claiming three withholding allowances. For annuity payments, your withholding certificate stays in effect until you change or revoke it. Jackson must notify you each year of your right to elect to have no tax withheld or to revoke your election. if you elect not to have withholding apply to your withdrawals, or if you do not have enough withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated lax payments are not sufficient. Complete the following applicable lines: You may be able te avoid quarterly estimated tax payments by having enough lax withheld from your paymients. | elect not to have state and federal income tax withheld from my pension or annuity. | efeet withholding from each periodic pension or annuity payment to be figured using the number of allowances and mariial status shown (you may aiso designate an amount in ihe box af the right). Number of allowances: Marital Status: [| [Single | [Married | {Married, but withholding at higher single rate. i] 1 elect the following addilionat amount withheld from each pension or annuity payment. Nofez For annuity payments, pene you cannot enfer an amount here without entering the number (including zero) of allowances above. $. lf your state of residence has state income tax, you may elect fo have taxes withheld using the same allowances and marital slatus as used for federal wilhholding. | elect to have state tax withheld. (Depending on the laws in your state, state income tax withholcing may be required. See "Important information" section on page 8 for state withholding requirements.) F. Beneficiary Designation — If you fave selected option A, B, C, D or E, then you must complete this section. Please name your bsreficiary(ies), For additional baneficiarias, please attach additional namefs) and requested information on a separate sheel, signed and dated. 1.[__] Primary bo Perceniage of Death Benefit Ce: moe erecta cecr AO arent arm mene aac FEAF SAR Hackl § eee | 1] ~ ELLE. DANIEL aoe MIL |\HESHe TAY -wtfos}r |! ! LoL ee ae 1 | HES a THE | 7 fel | | ES □ □ 5 Non-MaturalEntty Name Tax Identification Number Relationship to You | ae | □□ Son Address (number, strect} City 1 ‘State ZIP Code Phone Number {inckds arsa cote) $< <= 4 Beotwoon fe | Dye Beoow- || KY | 10573 Page 6 of 8 21142 03/18 06/01/2020 07:55:19 | Direct Deposit - you selected option C, D, or E, you may authorize direct deposit by completing this section. | hereby aulhorize Jackson to direct deposil into the checking or savings account identified below, until further notice, all contract payments due to the owner of the contract. If the contract ig owned by a trust, | affirm that | am the current trustee of the trust and am authorized to make this request on behalf of the trust. This authorization will remain in effect uniil itis revoked in writing. | and/or the trust hereby release and agree to indemnify and hold Jackson harmless from any and all claims arising out of or in any way related to Jackson's actions in compliance with this authorization. | agree thal Jackson will have no furiher liability wilh respect to any payments mace in accordance with this authorization and may, al any time, discontinue my direct deposit and issue checks to me requiring my personal endorsement. |, for myself, my heirs, executors, administrators, and assigns, do hereby consent and agree that any sums of money deposited to my account after my death shall be refunded to Jackson for distribution to the person or persons, if any, entilled to those sums under the terms of the contract, Checking Account (lape pre-printed voided check below) * Savings Account (provide letter from bank on institution's letterhead; letter must be signed and dated by a bank representative) * * Direct Deposit will not be established without receipt of a pre-printed voided check or letter from your bank. Please note: Contract payments will generate on the day they are due or the next business day and will be deposited inte your account within 2-3 business days (receipt of funds may be delayed by a weekend or holiday), All payments from custodian owned contracts will ba mada payable to the Custodian for both direct deposits and checks. Do not staple. Do not attach a deposit slip or a starter check. Account Holder's Name(s) 245 Main St. Anywhere, USA 00000 The OrderOt □□ ec ell ~ □□□□□□□□□□□□□□□□□□□□□□□□□□□ oil Tatlars Your Financial Institution □□ VO | D == Name Street Address — Cily, State, ZIP 12354 Your Transit Routing Number Your Account Number Your check number Page 5 of 8 21142 03/18 (06/01/2020 07:55:19 | Receiged OG MPHEARRY 07:55:19 Box DCC14062 O58IBF Contingent | GD | Percentage of Death Benefit Bonefidary's Name fFiret) ANIKI} {last} ____ Date ot Birth (mavcklyyyy) Social Secunty Number | Jonata | Setit | TAs | 69124) 1463 |] Non-Matural Entity Name Tax IGentifeation Number Relationship ip You Pfft sen Address (number, street) City erties State BP Gets Phone Nunijer {include area code Guaesioe «dicey Onl | coos | 3. [4 Primary [| Contingent | Percentage of Beath Beneiit Beneticiany's Name (First), (ice) (Last) Date ot Birth (mmviddiyyyy) Sectal Security Number Non-Natural Entity Name Tax Idantifieation Number Relationship to Yeu (qumber, street) City —_ States Cede Phone Number (inchide area cods) — □□□ □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ Note: All Primary Beneficiary percentages must be in whole percentage numbers thai total 100%. All Contingent Beneliciary percentages must also be in whole percentage numbers that total 100%. lf no beneficiary is alected, your Estate will be recorded. Signature({s) The undersigned hereby makes claim to the undersigned's share of the death benefit proceeds of the above annuily Contract as beneficiary and agrees that the furnishing of this form or any of the forms supplemental thereto by the Company shall not consiituie or be considered an admission by the Company that there was an annuity in force, nor shall it constitute or be considered a waiver of any of the Company's rights or defenses. THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING. Under penalties of perjury, | certify that: 1. The number shown on this form is my correct Taxpayer Identification Number. 2. fam not subject to backup withholding. lama U.S. citizen or other U.S. person {inciuding a U.S. resident alien). 4, 1am exempt from Foreign Account Tax Gompliance Act (FATCA) reporting. By signing below | acknowledge | have read all cptions available to me. Please note: ALL ELECTIONS ARE IRREVOCABLE, YOU MAY WISH TO GONTACT A TAX ADVISOR. Claimant's Signature Daie Signed (mmicktyyyy) Glaimant’s Name (First) (ice) (Last) | Ereente Yul | e5|1s| 2020] ELLEN | FES Hin Signature of Witness Data Sioned (mavedtyyyy) Winese’s Name (Firet) Micile Lasi) yyhal— | oslisl2oe0 | DANIEL | Marte | Tavs ad Page 7 of 8 21142 03/18 06/01/2020 07:55:19 Important Information - Please Read Carefully The entire death benefit must be paid within five (5) years of the date of dealh unless you elect to have the death benefit payable under an Income Option or the Systematic Withdrawal Option. The death benefil payable under an Income Option or the Systematic Withdrawal Option must be paid over your lifetime or for a period not extending beyond your life expectancy. For non-qualified funds, the first |RS-required withdrawal under the ISW and Income Option must occur within twelve months of the owner's death. Far Lump-Sum Distributions, non-qualified funds must be completely withdrawn by the fifth anniversary of the dale cf death. + For qualified funds, the first |RS-required withdrawal for the Stretch IRA and Income Option must occur by December 31st of the year following ihe owner's death, For lump-sum distributions qualified funds must be completely withdrawn by December 31 following the fifth anniversary of the date of death. + If you wish to elect an Income Option or the Systematic Withdrawal Opiion you must do so within the G0-day period beginning with the date Jackson receives proof of death. Please note: with Ihese options your beneficiary will not recelve any enhanced death benefit protections. Continuation Option is selected for a JNL Target Select® contract, the original allocation period will remain in effect. The Beneficiary will have the option to select a new allocation period upon renewal. Please note: the following states do not have state income tax. We are nol allowed to withhold slate tax for these slales: Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington and Wyoming. The following states allow you to elect out of state wilhholding: Califomia, Delaware, Oregon and Vermont. The state of Georgia allows you to elect oul of state withholding on benefit payments only. + Please note: if you are a Michigan resident, we may be required to withhold state tax al the prevailing fixed percentage. = lf you elect to have federal withhokling, we are required to withhold for slate purposes al the prevailing fixed percentage of ihe federal rate for the following states; Arkansas, California, Delaware, Georgia, lowa, Maine, Massachuselts, Mississippi, Nebraska, North Carolina, Oklahoma, Oregon, Vermont and Virginia. * The 10% premature distribution penally does nol apply to distributions made lo the beneficiary on or after the death of the original holder of the Contract. » Remember that there are penalligs for not paying enough tax during the year, elfher through withholding or estimated lax payments. New retirees, especially, should see IRS Publication 505, Tax Withholding and Estimated Tax, which can be oblained by contacting the IRS. Publication 505 explains the estimated tax requirements and penalties in delail. You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your payments. » Please fidte: if you continue a Contract with a LIB, you may set or change the Activation Date by completing the Activation Request Form (X4391). If an Activation Date has been sel, you may change or cancel that date by notifying ihe Company at leas! 30 days prior to the selected Aciivalion Date. If you do not notify the Company al least 30 days prior to the Activation Dates, il cannol be changed or canceled. Mailing Address and Contact Information Jackson Claims Administration Regular Mail P.O. Box 30503, Lansing, Ml 48003-6003 Overnight Mail 1 Coiporata Way, Lansing, MI45351 Customer Care 688-565-6995 (M-Th: 8900 sum, to 7.00 pm. ET and Fi: oem. b600pm.ET) - Fax* 517-708-5513 Enrail customarcare @jackson.com * Afax cover page is not needed. If you have additional instructions to submit please completa Letter of Instruction (form X4259} including owner and/or annuitant signature(s} as applicable, Page 8 of 8 21142 03/18 ee ea ee ag Ee a a en □□□ ee □□□ hae ek emcee, reap ee ee en ed ag ee ee ee Or eg a ta eg ee eee en ee ee □□ □□ □□ □□ □□□□ □□ we . WESHMESTER or:ssiis rue | | | 2h HL IF MAILED it <n IN THE □□□ ‘ch Me JUNITED STATES LES EEE BUSINESS REPLY MAIL cena FIRST-CLASS MAIL PERMITNO.600 LANSING Ml ee POSTAGE WILL BE PAID BY ADDRESSEE EEE ——————= Mofo gtaly ysl puabtatyatyay lf tytyoonf pally JACKSON NATIONAL LIFE INSURANCE COMPANY PO BOX 30503 LANSING MI 48909-9777 POLSINELLI PC Frank T. Spano Darnell Stanislaus 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 fspano@polsinelli.com dstanislaus@polsinelli.com Attorneys for Plaintiff UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK JACKSON NATIONAL LIFE INSURANCE COMPANY, Case No. Plaintiff NOTICE OF MOTION v. ELLEN A. IFSHIN f/k/a ELLEN, A. BOND and GREGORY T. BOND, Defendant PLEASE TAKE NOTICE that upon the Declaration of Theresa Thompson, the Interpleader Complaint and the exhibits attached thereto, and the accompanying Memorandum of Law, Plaintiff Jackson National Life Insurance Company (“Jackson National”) will move this Court, at the United States Courthouse for the Southern District of New York, located at 300 Quarropas Street, White Plains, New York, at a date and time to be designated by the Court, for an order granting Jackson National leave to deposit into the Court’s Disputed Ownership Fund in an interest bearing account the death benefit owed under an annuity issued to Focus 2000 for Annuitant Philip G. Bond, and: (a) discharging Jackson National from further liability under the annuity; (b) enjoining the competing claimants from initiating any separate action against Jackson National and/or its agents with respect to the Annuity; (c) awarding Jackson National its reasonable attorney’s fees and costs; and (d) dismissing Jackson National from this action. Dated: New York, New York September 2, 2020 POLSINELLI PC By: /s/ Frank T. Spano 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 Fax No. (212) 684-0197 fspano@polsinelli.com dstanislaus@polsinelli.com ATTORNEYS FOR PLAINTIFF POLSINELLI PC Frank T. Spano Darnell Stanislaus 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 fspano@polsinelli.com dstanislaus@polsinelli.com Attorneys for Plaintiff UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK JACKSON NATIONAL LIFE INSURANCE COMPANY, Case No. Plaintiff v. ELLEN A. IFSHIN f/k/a ELLEN, A. BOND and GREGORY T. BOND, Defendant MEMORANDUM OF LAW IN SUPPORT OF PLAINTIFF’S MOTION TO DEPOSIT POLICY BENEFIT INTO THE COURT’S REGISTRY AND FOR INTERPLEADER RELIEF Plaintiff Jackson National Life Insurance Company (“Jackson National”) respectfully submits this memorandum of law in support of its Motion to Deposit Policy Benefit into the Court’s Disputed Ownership Fund and for Interpleader Relief. I. FACTUAL BACKGROUND 1. On January 3, 1989, Jackson National issued a Flexible Premium Deferred Annuity Policy, bearing Policy Number 0004865310 (the “Annuity”) to Focus 2000 with Philip G. Bond, deceased being the annuitant (“Annuitant”). See Declaration of Theresa Thompson at ¶ 3. 2. The proceeds of the Annuity are subject to competing claims as the result of the death of Annuitant. See id. at ¶ 4. 3. On or around February 21, 2020, Jackson National was provided, among other things, a certificate of death of Annuitant, who died on July 1, 2016, as a resident of San Diego, California. Seeid. at ¶ 5. 4. As of August 12, 2020, the value of the Annuity’s death benefit proceeds is $15,297.56 (the “Proceeds”). Seeid. at ¶ 6. 5. The Annuity identifies the primary beneficiary as Ellen A. Ifshin f/k/a Ellen A. Bond (“Ifshin”), Annuitant’s ex-wife and the contingent beneficiary as Gregory T. Bond (“Bond”), Annuitant’s son. Seeid. at ¶ 7. 6. On February 21, 2020, Bond provided to Jackson National an executed claim form, along with a Marital Settlement Agreement between Annuitant and Ifsin. Seeid. at ¶ 8. 7. On March 14, 2020, Jackson National sent correspondence to Bond informing him that Ifshin was the designated beneficiary of the Annuity. Seeid. at ¶ 9. 8. On May 4, 2020, Jackson National sent correspondence to Ifshin advising her that she was the named beneficiary under the Annuity and asking her to return an executed claim form if she intended to claim the proceeds of the Annuity by June 1, 2020. Seeid. at ¶ 10. 9. On May 4, 2020, Jackson National notified Bond that Annuitant’s divorce from Ifshin did not automatically revoke her designation as the beneficiary of the Annuity and asked Bond to notify Jackson National if he disagreed. Seeid. at ¶ 11. 10. On May 16, 2020, Jackson National received Ifshin’s Election Regarding Claim Proceeds in which she claimed she was the proper beneficiary of the Annuity and intended to file a claim for the Annuity’s death benefit proceeds. Seeid. at ¶ 12. 11. On May 12, 2020, Bond sent a letter to Jackson National, stating that if Ifshin attempted to claim the Proceeds he would contest her claim. Seeid. at ¶ 13. 12. On June 1, 2020, Jackson National received from Ifshin an Annuity Death Benefit Claim Form indicating that she elected to claim the Proceeds. Seeid. at ¶ 14 13. Jackson National is unable to determine the validity of the conflicting and competing claims to the Proceeds of the Annuity and fears that payment of the Proceeds to any one claimant will subject it to additional liability to the other claimants seeking payment of the Proceeds under the Annuity. 14. Jackson National has no interest in the Proceeds except to the extent such payment discharges any and all obligations Jackson National may owe to any party arising out of the Annuitant’s death and the benefit payable as a consequence thereof under the Annuity. 15. On this same day, Jackson National filed this statutory interpleader action pursuant to 28 U.S.C. § 1335 as a disinterested stakeholder claiming no interest in the Proceeds of the Annuity. II. LEGAL ARGUMENT A. Jackson National is Entitled to an Order to Permit Deposit of the Proceeds into the Disputed Ownership Fund of this Court. This Court has held that in order to exercise jurisdiction over a statutory interpleader action under 28 U.S.C. § 1335 , the interpleader plaintiff must deposit the money or property at issue into the registry of this Court. See, e.g. Fed. Ins. Co. v. Tyco Int’l, Ltd., 422 F.Supp.2d 357 (S.D.N.Y. 2006). Pursuant Fed.R.Civ.P. 67(a), Jackson National requires an order from this Court to direct the Clerk to permitting deposit on the Proceeds. Accordingly, Jackson National respectfully requests and order from this Court allowing Jackson National to deposit the Proceeds into the Court’s Disputed Ownership Fund, and, thereafter, to be discharged from further liability with respect to the Proceeds and the Annuity and to be dismissed from this action. B. Jackson National is Entitled to an Injunction Against Duplicitous Actions 28 U.S.C. § 2361 provides that In any civil action of interpleader or in the nature of interpleader under section 1335 of this title, a district court may issue its process for all claimants and enter its order restraining them from instituting or prosecuting any proceeding in any State or United States court affecting the property, instrument or obligation involved in the interpleader action until further order of the court. This Court has determined that an “injunction against overlapping lawsuits is desirable to insure the effective of the interpleader remedy. It prevents the multiplicity of actions and reduces the possibility of inconsistent determinations.” Sotheby’s Inc. v. Garcia, 802 F.Supp. 1058 (S.D.N.Y. 1992) Accordingly, Jackson National further requests that the Court enter an Order restraining Defendants, their heirs, legal representatives, successors and assigns, and all other persons claiming by, through, or under them, be permanently enjoined and restrained from instituting or prosecuting any action in any state or United States Court against Jackson National and its agents and representatives with respect to the Annuity or the Proceeds. C. Jackson National is Entitled to an Order of Dismissal Upon Jackson National’s deposit of the Proceeds into the registry of the Court, Jackson National respectfully requests an order of discharge from further liability with respect to the Annuity and the Proceeds and an order of dismissal from this action. D. Jackson National Requests its Attorneys’ Fees Finally, Jackson National requests an order awarding Jackson National its attorneys’ fees and costs to be paid from the Proceeds. Jackson National is a disinterested party that was forced to bring the present suit after competing claims by the ex-wife and son of the Annuitant. Dated: New York, New York September 2, 2020 POLSINELLI PC By: /s/ Frank T. Spano 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 Fax No. (212) 684-0197 fspano@polsinelli.com dstanislaus@polsinelli.com ATTORNEYS FOR PLAINTIFF POLSINELLI PC Frank T. Spano Darnell Stanislaus 600 Third Avenue, 42nd Floor New York, New York 10016 (212) 684-0199 fspano@polsinelli.com dstanislaus@polsinelli.com Attorneys for Plaintiff UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK JACKSON NATIONAL LIFE INSURANCE COMPANY, Case No. Plaintiff v. ELLEN A. IFSHIN f/k/a ELLEN, A. BOND and GREGORY T. BOND, Defendant DECLARATION OF THERESA THOMPSON IN SUPPORT OF MOTION TO DEPOSIT Theresa Thompson, pursuant to 28 U.S.C. §1746 , and under penalties of perjury, hereby affirms and states as follows: 1. I am a Claims Examiner at Jackson National Life Insurance Company (“Jackson National”), the plaintiff in this action. The information contained herein is either personally known to me or has been obtained from (1) people whom I believe to be reliable and capable of ascertaining the facts described herein or (2) records maintained by Jackson National. 2. I submit this declaration in support of Jackson National’s motion for an order permitting the deposit of the proceeds of Jackson National Flexible Premium Deferred Annuity Policy, bearing Policy Number 0004865310 (the “Annuity”) into the Registry of this Court. 3. The Annuity was issued on January 3, 1989 to Focus 2000 with Philip G. Bond, being the annuitant (“Annuitant”). See Annuity, attached as Exhibit 1. 4. The proceeds of the Annuity are subject to competing claims as the result of the death of Annuitant. 5. On or around February 21, 2020, Jackson National was provided, among other things, a certificate of death of Annuitant, who died on July 1, 2016, as a resident of San Diego, California. See February 21, 2020 Fax to Jackson National, attached as Exhibit 2. 6. As of August 12, 2020, the value of the Annuity’s death benefit proceeds is $15,297.56 (the “Proceeds”). 7. The Annuity identifies the primary beneficiary as Ellen A. Ifshin f/k/a Ellen A. Bond (“Ifshin”), Annuitant’s ex-wife and the contingent beneficiary as Gregory T. Bond (“Bond”), Annuitant’s son. See Annuity, attached as Exhibit 1. 8. On February 21, 2020, Bond provided to Jackson National an executed claim form, along with a Marital Settlement Agreement between Annuitant and Ifsin. See February 1, 2020 Fax from Bond to Jackson National, attached as Exhibit 2. 9. On March 14, 2020, Jackson National sent correspondence to Bond informing him that Ifshin was the designated beneficiary of the Annuity. See March 14, 2020 Letter to Bond, attached as Exhibit 3. 10. On May 4, 2020, Jackson National sent correspondence to Ifshin advising her that she was the named beneficiary under the Annuity and asking her to return an executed claim form if she intended to claim the proceeds of the Annuity by June 1, 2020. See May 4, 2020 Letter from Jackson National to Ifshin, attached as Exhibit 4. 11. On May 4, 2020, Jackson National notified Bond that Annuitant’s divorce from Ifshin did not automatically revoke her designation as the beneficiary of the Annuity and asked Bond to notify Jackson National if he disagreed. See May 4, 2020 Letter from Jackson National to Bond, attached as Exhibit 5. 12. On May 16, 2020, Jackson National received Ifshin’s Election Regarding Claim Proceeds in which she claimed she was the proper beneficiary of the Annuity and intended to file a claim for the Annuity’s death benefit proceeds. See May 16, 2020 Election Regarding Claim for Proceeds, attached as Exhibit 6. 13. On May 12, 2020, Bond sent a letter to Jackson National, stating that if Ifshin attempted to claim the Proceeds he would contest her claim. See May 12, 2020 Letter from Bond to Jackson National, attached as Exhibit 7. 14. On June 1, 2020, Jackson National received from Ifshin an Annuity Death Benefit Claim Form indicating that she elected to claim the Proceeds. See Ifshin Annuity Death Benefit Form, attached as Exhibit 8. I declare under penalty of perjury that the foregoing is true and correct. DATED: August 21, 2020 DocuSigned by: [ tune Thompson. . 66459ACED2E7445... LUCLesd LUOUIPSOU 744858172 JACKSON NATIONAL LIFE INSURANCE COMPANY 1 Corporate Way Lansing, Michigan 48951 A Stock Company Will pay the benefits provided in this policy, subject to its terms and conditions ® POLICY NUMBER 0004865310 POLICY DATE JANUARY 3, 1989 THE ANNUITANT PHILIP G BOND AGE 50 MALE THE OWNER FOCUS 2000 PLAN FLEXIBLE PREMIUM DEFERRED . ISSUEDATE JANUARY 3, 1989 ANNUITY ANTICIPATED MATURITY DATE: NOVEMBER 3, 2013 ANTICIPATED ANNUAL PREMIUM: $12,000.00 INITIAL PREMIUM DEPOSIT: $1,000.00 BENEFICIARY ELLEN A BOND PREMIUM ae Schedule: ANNUALLY PREMIUM Payable as follows ON THE DUE DATES PRIOR TO MATURITY Beginning: Month Day Year Total PREMIUM: JANUARY 3 1989 $12,000.00 INDIVIDUAL DEFERRED This contract is signed at the home office of ANNUITY CONTRACT WITH Jackson National Life, Lansing, Michigan FLEXIBLE PREMIUMS DEATH BENEFIT PRIOR. TO MATURITY. MONTHLY INCOME AT MATURITY. Le NON-PARTICIPATING Secretary President. A307 CONTRACT PROVISIONS SECTION PAGE Basic Benefits □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ OD General ProviSiONns □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ O Accumulated Value Provisions □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ A Annuity Provisions □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ Settlement Option Table □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ 6 Form No. 3007 DA 7/82 Page 2 BASIC BENEFITS THE COMPANY WILL PAY the Annuitant, if living on the Maturity Date, a monthly life income annuity with 12( months certain. The amount will be as shown on the Table of Guaranteed Values page of this Policy or such greate amount as determined by the terms of this Policy. Upon receipt of due proof of the death of the Annuitant prior to the Maturity Date, the Company will pay to th Beneficiary, no later than two months after receipt of such proof, the Death Benefit Proceeds. The Death Benefi Proceeds will be equal to: 1) the total amount of premiums paid without interest and reduced by the sum of all Partial Withdrawal Amounts; or 2) the Accumulation Value, if greater. GENERAL PROVISIONS OWNER OF THE POLICY While the Annuitant is MISSTATEMENT OF AGE OR SEX If the age or se? living, all rights of this Policy belong to the Owner. The of the Annuitant has been misstated, the benefits availabl Owner may exercise these rights subject to the interest of under this contract will be those which the premiums pai any Assignee or irrevocable Beneficiary. would have purchased at the correct age and sex. CHANGE OF OWNERSHIP The ownership of this Any underpayments will be made up immediately by th : . ..,, Company. Overpayments will be deducted fron Policy may be changed at any time during the Annuitant’s di t lifetime. Such change must be made by written notice succeeding, Payments as necessary. acceptable to the Company. A change will take effect on CONSIDERATION: ENTIRE CONTRACT Thi the date the notice is signed. However, the change will not consideration for issuing this Policy is the Application an apply to any payments made or actions taken by the the payment of the first premium. This Policy and th Company before the notice was received at the Home Application, a copy of which is attached and made a part o Office. The Company reserves the right to require that this the Policy, constitute the entire contract between th Policy be presented for endorsement of any change. parties. All statements made in the Application will, in th HOW BENEFICIARY MAY BE CHANGED While absence of fraud, be deemed representations | and no . os warranties; and no statement will void this Policy or b this Policy is in force, the Owner may change the vs . □ . : used as a defense to a claim unless it is contained in suc! Beneficiary, unless otherwise provided by endorsement. ten applicati This may be done by filing at the Home Office of the written applicalion. Company an acceptable written request. Such change will MODIFICATION OF POLICY Only the President, | be subject to any existing assignment of this Policy and Vice President, the Secretary, or an Assistant Secretary o will take effect only when recorded by the Company at its the Company has power on behalf of the Company t Home Office. When recorded, the change will take effect change, modify, or waive the provisions of this Policy an on the date the notice was signed. Any proceeds paid then only in writing. No agent or persons other than th before a change of Beneficiary is recorded will not be above named officers has the authority to change or modif subject to the change. this Policy or waive any of its provisions. DEATH OF BENEFICIARY The interest of any ISSUE DATE Unless otherwise stated on the face o Beneficiary who dies before the Annuitant will end at the this Policy, the issue date will be the date used t death of the Beneficiary. The interest of any Beneficiary determine due dates, policy anniversaries and policy years. who dies at the time of or within ten days after the death of CHANGE OF ANTICIPATED MATURITY DAT} the Annuitant will also end if no proceeds have been paid : □□ . . . While this Policy is in force, the Owner may change th to that Beneficiary. If the interest of all designated Antici . nticipated Maturity Date to a date later than that show: Beneficiaries has ended, any proceeds will be payable to : . : . on the face of this Policy by filing a written request at th the estate or legal successors of the Annuitant. : Home Office of the Company. NONPARTICIPATING This Policy will ne participate in the profits or surplus of the Company. Form No. 109 DA 11/86 Page ACCUMULATED VALUE PROVISIONS ACCUMULATED VALUE The Accumulated Value is When a Partial Withdrawal is made, the Partia equal to the Net Amount of each premium, less all Partial Withdrawal Amount will be taken from the Accumulate: Withdrawal Amounts, accumulated at interest and reduced Value arising from the first-year premium and interes by the Annual Administrative Charges if applicable. thereon before any other premiums and interest. Interest will be credited from the date a premium is FULL WITHDRAWAL At any time prior to th received by the Company and will cease to be credited on Maturity Date, the Company will, upon written □□□□□□□□□□□ Partial Withdrawal Amounts on the date the Partial by the Owner and surrender of the policy, pay to th Withdrawal is granted by the Company. Owner the Cash Surrender Value of the policy. ADDITIONAL PREMIUM PROVISION The SURRENDER CHARGE The Surrender Charge is | Company will accept additional premium payments after percentage of the Accumulated Value of the first-yea the initial payment at any time prior to the election of an premium and interest thereon for either a Full Withdrawa annuity payment option and in any amount not less than or Partial Withdrawal. The Surrender Charge percentage $50. policy year is shown on the Policy’s Table of Guarantee: If premium payments are discontinued, the existing Values page. Accumulated Values will continue to accumulate as The Company may defer payment of any withdrawa described in the “Accumulated Value” section. amount for a period not exceeding six months. ANNUAL ADMINISTRATIVE CHARGE At the end ANNUAL STATEMENT OF VALUES The Compan: of each policy year, an administrative charge of $20 will be shall provide to the Policyowner annually a statemen deducted from the Accumulated Value of each contract on showing premiums paid, partial or full withdrawals grante which premiums had been paid in the policy year. Except and the then current accumulation and cash surrende that such charge will be waived in each year in which values. premium payments total at least $1,000. INTEREST OF THE OWNER The interest of thi NET AMOUNT OF EACH PREMIUM The Net Owner in the Accumulated Value prior to the Maturit Amount of each premium is equal to the total premium Date will at all times be nonforfeitable. received by the Company reduced by the applicable INTEREST Interest will be credited to th premium tax rate in effect on the date the premium is Accumulated Value from the date premiums are receive received and reduced by a collection charge of $1.25. This by the Company until withdrawals are granted by th collection charge will be waived and not deducted from Company. The rates of interest will be as the Board o any premium which equals or exceeds $1,000. Directors of the Company may declare, in advance. Sucl CASH SURRENDER VALUE The Cash Surrender rate of interest will never be less than the rate shown on th Value is equal to the Accumulated Value, less the Table of Guaranteed Values page. Such interest credite Surrender Charge. which exceeds these rates will be excess interest and wil PARTIAL WITHDRAWAL AMOUNT The Partial be added to and become part of the Accumulated Value Withdrawal Amount means any amount less than the Cash On contracts where less than $1,500 of premium has bee: Surrender Value, which is withdrawn from the paid during the most recent 24 months, the Board o Accumulated Value. Directors may declare lower or no excess interest. NET WITHDRAWAL AMOUNT The _ Net RESERVE BASIS The reserve under this Policy prio Withdrawal Amount is equal to the Partial Withdrawal to the commencement of any annuity payment will b Amount less the Surrender Charge. equal to the Cash Surrender Value then current, or th PARTIAL WITHDRAWAL At any time prior to the greatest of the discounted future Cash Surrender Value Maturity Date, the Owner upon written application, may discounted at the valuation interest rate permitted by law withdraw a Partial Withdrawal Amount, subject to the whichever is greater. After that, the reserve will equal th terms of this Policy. The Partial Withdrawal Amount must present value of future annuity benefits provided. be such that the remaining Accumulated Value after The Cash and Annuity Values provided under thi withdrawal is not less than 15 percent of the Accumulated Policy meet or exceed the minimum levels required by th Value immediately prior to the Partial Withdrawal. In no laws of the state in which this Policy is delivered. / case may the remaining Accumulated Value be less than detailed statement of the method of computing values ha $1,000. been filed with the supervisory official of the state wher this Policy is delivered. Form No. 253 DA 11/86 Page 4 ANNUITY PROVISIONS ANNUITY BENEFITS At the Maturity Date selected there are less than 120 monthly payments, the Cas} by the Owner, the Accumulated Value will be applied to Surrender Value will be applied instead of th provide an annuity payable for 120 months certain and life Accumulated Value. Payment under this Option is subjec as determined from this Policy, or other more favorable Satisfactory proof of the age of the Payee. options as the Company may make available. ‘The Owner MINIMUM PAYMENTS | ! he minimum paymen : os . under Option 1 is $100. The minimum payment under any may elect to receive an annuity in accordance with the yt ns . : . of the other Options is $25. other Options shown in the Policy or made available by the EFFECT OF TAXES ASSESSED AT MATURITY Company. At the death of an Annuitant before the Maturity OR TIME OF ELECTION OF AN OPTION In the even Date, the Beneficiary may elect to receive an annuity by a premium tax or other tax is assessed at the time payment: applying the death benefit proceeds under any of the begin, the amount of such tax will reduce the proceed: following Options or other more favorable Options as the which would otherwise be applied. Company may make available. Election of an Option must EXCESS INTEREST Excess Interest as declared by be made in writing to the Company. The effective date of the Company may be used to increase payments or t any election of an Option will be determined by the increase the period of time for which payments are made. election. ELECTION OF SETTLEMENT OPTIONS BY) PAYMENT OPTIONS The proceeds may be applied OWNER T he Owner may elect or change any paymen , □□ option during the lifetime of the Annuitant. The election o under any of the following Options: sh van b deb itt tice to the C. OPTION 1 - PROCEEDS AT INTEREST The Cash ““SPECtON. OF PAYMENT OPTIONS. BY Surrender Value or the Death Benefit Proceeds may be left peNERICIARY If no payment Option is in effect at th on deposit during the lifetime of the Payee or for a death of the Annuitant, a payment Option may be electec specified period. Interest will then be paid annually. The by the Beneficiary. The election can be made by □□□□□□ rate of interest will be no less than 4% per year. All or part notice to the Company. of the proceeds may be withdrawn at any time. ADJUSTED AGE The adjusted age is determined fron OPTION 2 - PAYMENT FOR A FIXED PERIOD | the actual age and the calendar year of birth. The Accumulated Value or the Death Benefit Proceeds Calendar Year of Birth Adjusted Age may be paid in monthly payments, until the proceeds plus Before 1900 Actual age Plus 2 interest at no less than 4% per year are paid in full. The 1900-1919 Actual age plus 1 period is shown in the table. If there are less than 120 1920-1939 Actual age monthly payments, the Cash Surrender Value will be 1940-1959 Actual age minus | applied instead of the Accumulated Value. The present 1960-1979 Actual age minus 2 value of any unpaid payments may be withdrawn at any 1980 and After Actual age minus 3 time and will be if a Payee dies before the last payment is AVAILABILITY OF OPTIONS These Options are no made, available if the Beneficiary is an Assignee, Corporation OPTION 3 - LIFE INCOME The Accumulated Value rang Fide oye Trustee, Executor, Administrato or the Death Benefit Proceeds may be paid in monthly "FREQUENCY OF PAYMENTS The payments show: payments during the lifetime of the Payee. A munimun in the table are monthly payments. Payments may be mad number of payments may be guaranteed if desired. The one, two or four times per year if desired. These payment amounts of the monthly payments are shown in the table. gre obtained as follows: They are based on the 1971 Individual Annuity Mortality Number of Payments Per Year Method of Calculation Table with interest at 6%. Payment under this Option is One Monthly Payment Multiplied subject to satisfactory proof of the age of the Payee. If the by 1.787 0 : Two Monthly Payment Multiplied Payee dies before the guaranteed payments have been paid, by 5.951 the present value of the remaining guaranteed payments Four Monthly Payment Multiplied will be paid. by 2.990 The present value of any unpaid payments under any option will be calculated using 4% interest. OPTION 4 - CURRENT ANNUITY OPTION The Accumulated Value or the Death Benefit Proceeds may be used to purchase any single premium immediate annuity which is issued by the Company on the date of election. If Form No. 327 DA 11/86 Page § TABLE OF ANNUITY OPTIONS The following table is for a contract whose net proceeds are $1,000, and will apply pro rata to the amount payable under this policy. OPTION 2 MONTHLY INSTALLMENT UNDER OPTION 3-CONTINUOUS INSTALLMENTS No of Monthly Adjusted Age No. of Mos. Certain Adjusted Age No. of Mos. Certain Adjusted Age No. of Mos. Certain | Install- of Payee of Payee of Payee Install- ments ments | Male | Female | tite | 120 | 240 | Male | Femate | vite | 120 | 240 | male | Female | Lite | 120 | 240 12 $84.84 26 $4.93 | $4.92 | $4.91 441 47 $5.53 | $5.49 | $5.39 62 68 $7.46 | $7.08 | $6.33 24 43.25 27 4.94 4.94 4.92 | 42 48 5.58 5.54 5.43 63 69 7.62 7.20 6.37 36 29.40 28 4.96 4.95 4.94 43 49 5.63 5.59 5.46 64 70 7.80 7.33 6.42 48 22.47 29 4.98 4.97 4.95 44 50 5.69 5.64 5.50 65 71 7.99 7.46 8.46 60 18.32 30 5.00 4.99 497 | 45 51 5.75 5.70 5.54 66 72 8.19 7.60 6.51 72 15.56 31 5.02 5.01 4,99 46 52 5.82 5.75 5.58 67 73 8.41 7.74 6.54 84 13.59 | 26 32 5.04 5.03 5.01 47 53 5.89 5.81 5.62 68 74 8.65 7.88 6.58 96 12.12 | 27 33 5.06 5.05 5.03 | 48 54 5.96 5.87 5.66 69 75 8.90 8.04 6.61 108 10.97 | 28 34 5.07 5.07 5.05 49 55 6.03 5.94 5.71 70 76 9.18 8.19 6.64 120 10.06 | 29 35 5.10 5.09 5.07 50 56 6.11 6.00 5.75 71 7 9.48 8.35 6.67 132 9.31 30 36 5.12 5.11 5.08 51 57 6.19 6.07 5.79 72 78 9.80 8.51 6.69 144 8.69 31 37 5.15 5.14 5.10 52 58 6.28 6.14 5.84 73 79 10.15 8.67 6.71 156 B17 | 32 38 5.18 5.17 5.13 53 59 6.37 6.22 5.89 74 80 40.52 8.83 6.73 168 7.72) 33 39 5.21 5.20 5.15 | 54 60 6.46 6.30 5.94 75 10.93 9.00 6.74 180 7.34 | 35 40 5.24 5.23 5.18 | 55 61 6.56 6.38 5.98 76 41.37 9.16 6.75 192 7.00 | 35 4 5.27 5.26 5.21 56 62 6.67 6.47 6.03 7 11.85 9.31 6.76 204 6.71 36 42 5.34 5.29 5.24 57 63 6.78 6.56 6.08 78 12.37 9.47 6.76 215 6.44 | 37 43 5.35 5.33 5.26 | 58 64 6.90 6.65 6.13 79 12.93 9.62 6.77 228 6.24 38 44 5.39 5.37 5.29 59 65 7.03 6.75 6.18 80 13.54 9.76 6.77 240 6.00 | 39 45 5.43 5.41 5.33 | 60 66 7.16 6.86 6.23 40 46 5.48 5.45 5.36 61 67 7.30 6.97 6.28 No. 328 DA 11/86 Page 6 JACKSON NATIONAL LIFE INSURANCE COMPANY 1 Corporate Way Lansing, Michigan 48951 ® TABLE OF GUARANTEED VALUES PLAN: FLEXIBLE PREMIUM DEFERRED ANNUITY ISSUE AGE - 50 MALE POLICY NO: 0004865310 ANNUAL PREMIOM - $12,000.00 THE VALUES SHOWN BELOW ARE BASED ON THE PREMIUM SHOWN ABOVE, PAID ANNUALLY IN ADVANCE ON EACH POLICY ANNIVERSARY, AND ON THE GUARANTEED ANNUAL INTEREST RATE, SINCE INTEREST IS CREDITED ON THE ACTUAL NET AMOUNT OF EACH PREMIUM PAYMENT FROM THE DATE IT IS RECEIVED, THE VALUES OF THIS POLICY WILL VARY ACCORDINGLY. THESE VALUES WILL BE INCREASED BY ANY AMOUNTS OF EXCESS INTEREST DECLARED BY THE BOARD OF DIRECTORS AND WILL BE REDUCED BY ANY PARTIAL WITHDRAWALS. END OF ACCUMULATED CASH. GUARANTEED MONTHLY POLICY VALUE SURRENDER INCOME LIFE ANNUITY WITH 10 YEAR VALUE YEARS CERTAIN AT AGE 70 1 $12,360.00 $8,034.00 $117.50 2 $25,090.80 $20,635.02 $349,84 3 $38,203.52 $33,614.07 $517.15 4 $51,709.63 $46,982.49 $679.60 5 $65,620.92 $60,751.97 $837.31 6 $79,949.55 $75,364.39 $990.42 7 $94,708.04 $90.428.08 $1,139.08 8 $109,909.28 $105,956.96 $1,283.41 9 $125,566.56 $121,965.39 $1,423.53 10 $141,693.56 $138,468.16 $1,559.57 1] $158,304.37 $155,646.64 $1,691.66 12 $175,413.50 $173,360.49 $1,819.89 13 $193,035.91 $191,626.12 $1,944.39 14 $211,186.99 $210,460.95 $2,065.26 15 $229,882.60 $229,882.60 $2,182.61 16 $249,139.08 $249,139.08 $2,296.54 17 $268,973.25 $268,973.25 $2,407.16 18 $289,402.45 $289,402.45 $2,514.55 19 $310,444.52 $310.444.52 $2,618.82 20 $332,117.86 $332,117.86 $2,720.05 AGE 60 $141,693.56 $138,468.16 $1,559.57 AGE 70 $332,117.86 $332,117.86 $2,720.05 THE SURRENDER CHARGE PERCENTAGE BY POLICY YEAR IS AS FOLLOWS: * FIRST 5 POLICY YEARS 35% 9TH POLICY YEAR 23% 13TH POLICY YEAR 8% 6TH POLICY YEAR 32% 10TH POLICY YEAR 20% 14TH POLICY YEAR 4% 7TH POLICY YEAR 29% 11TH POLICY YEAR 16% 15TH AND LATER 8TH POLICY YEAR 26% 12TH POLICY YEAR 12% POLICY YEARS 0% * APPLIED TO ACCUMULATION OF PREMIUMS PAID IN FIRST POLICY YEAR ONLY THE GUARANTEED INTEREST RATE IS 3.00% COMPOUNDED ANNUALLY. A307 Ho APPLICATION TO A 082907 ’ JACKSON NATIONAL LIFE INSURANCE COMPAINY / LANSING, MICHIGAN a FOR FLEXIBLE PAYMENT ANNUITY CR SINGLE PAYMENT ANNUITIES, 4 -1.Full name of Annuitant (First, Middle and Last Name) ‘7 PLEASE PRINT aU Uy 5 Bk ay Sex >t _ Mate □ Pele Pl el iol TLL Ti titi □□□ Teme, 2 Addrass Number and Street ~ State Zin Coda Minus Dee Syworewo len |¢zvo ‘| 8, Dale of Birth Month | Day Year = | peibemaunyy Nuno (rust be filed in) 2. - (SBF SO cary! 2! 4. Employer Uccupalio ros Hale Employed Focus 2000 REAL ESTATE OFVELOER | 7 Baneticia Siam = lf onbngant Benehciary □ | Relatonshi Pat. derh! ge BOK D 30a OsEL fencer T. Got%) 3 oA) is understood that ownership and contro! of the Contract to ha issued on tne basis of this statement will be vested in O The Annutant 3 Other than the Annutant Fae tA ey Zoee {SHOW NAME, ADDAESS, AND SOCIAL SECURITY ; OR BUSINESS IDENTIFICATION NUMBER tf LIM ISB-O28 7TH 7 OWNER iS OTHER THAN anUTANT ee Payment Notice to: (if other than Ho 2 above Nama Number and Stet PF OLYS aooe d State Zip Code PHIe/P BowNTRUSTE \ires c1sdway OR, Shy 1@O |cA $2IIO 8. THIS APPLICATION IS FOR A PLAN CODE 12 Qurer Retains Richt : FLEX Ii ANNUITY 822 fo cnange Beneficie y Yes A’ No the annully purchased on a lac-qualihed Basis? We ho AnopaedRemomiage TCS” 14 Is ths Conttact to replace any exuting A lifa insurance pobcy or annuity pohcy? □□ Yes □□ ‘WT contract Ts purchased to fund @ qualihed plan, please indicata If $0, gve Completa detats appropriata section of Internal Revonue Code 0 IRA (Saction 408) □ O Seif Employed (Section 401 Ti Sjanal Aegueas. ecm Anat Sete ae "AMULTALY RETAINS RIGHT rqanization (Sectron 0) Public Schoo! System (Section 403b Te ARGE FEMEFICIARY O Betetred Compensation (Plan Document Enclose 20S ee ee □ O Simplified Employee Fension (Section 408) . : 11, Payment Intormation for Flexibla Contract 4} § & 53 [ _—a.tnital Payment § ff @ee@ b. Anticipated sna oanen Séaky ONG f . □ Mode of Payment (Circle One) (A) S QO PAC BOP JAH O3 1729 □ IMPORTANT: MAKE ALL, CHECKS PAYABLE ONLY TO JACKSON NA AL LIFE INSURANCE CO, GENERAL INFORMATION Nole that: 1, The acceptance of tha Comract issued on this appticalion shallconshtuta 3 Upon acceptanca of a Contract other than as applied for, this applica □ aralification of any change correchon or addon made by the Com- bon {including <iny enio’sements in 16 above) shallbe for sach modified □ pany and noted in the space headed "Homa Olfice Endorsements” Contract, excep! that wdite tequited by statute of Insuranica Department □□ 2. There has been celivered to the agant with this apphcation tegulation any change i plan, amount, Classification o benefits shail □ sf fines opal only to Jackson National Life insur- be made only upea written agreement, 2 - bad ance which shail not be considered payment hereunder unless 4 The undersigned hereby represents In the bast of his (Ihelty knowledge □□ actually honored upon preseniation by the Company in the due course that each of tha statements and answers contained above are com- □ of business plete and (nue, □ : Cash Received Daled and | With Application $f @G@s— Signed at Suv Die CA on fee 22 □□ cy Wf eye 54098 WY IG : ereatain. MOB Seg AGO ween eter | Sag □□□ AGS Taig ager AR a Cael en tad Q = TOSI □□ . Form No, 9288 REV. 11/82 - Ba 2020-02-21 11354 Costco W 130 sign 3236611475 >> FAXCORE P 1 To: Jackson National Life Insurance Company From: Gregory Bond Re: Policy #0004865310, Philip Bond Date: February 21, 2020 Attached: 1) Copy Of Jackson Letter Dated February 6, 2020 - 1 Page 2) Claim Form - 8 Pages 3) Certified Death Certificate - 1 Page 4) Certified Marriage Dissolution - 27 Pages Total of 37 Pages + Cover Sheet Fax to: (517) 706- 5513 2020-02-21 11:54 Costco W 130 sign 3236611475 >> FAXCORE P2 (02/21/2020 15:07:06 JACKSON NATIONAL LIFE INSURANCE COMPANY Adnunisiration February 6, 2020 Ellen A Bond Gregory T Bond 29506 Mammoth Ln Canyon Country, CA 91387 |URGENT: IMMEDIATE REPLY REQUIRED | □ Deveased: Philip G Bond Policy 9004865310 Dear Ellen A Bond; One mvurds waionts thee 00 BAA, Bawds techs el tae Ui lecinal Pods uy to Ui braid y all lee above listed policy with an approximate value of $8,050.64, To date, we have not reccived the following documents necessary lor consideration of his claim, + Clair Form * Final Certified Death Certificate This property may be cacheated to the state if the beneficiary docs mot come forward to clair the funds. YOUR RESPONSE MUST BE RECELVED WITHIN 30 DAYS FROM THE DATE QF ‘THIS LETTER to prevent these funds [rom being reported to the state of California as unclaimed property, LE you have additional questions or concerns, please contact our Service Center at 888/565-4995, Monday through ‘hursday, 8:00 a.m, to 7:00 p.m. and Friday $:00 a.m. to 6:00 p.m. (ET), You may also contact Jackson via cmail through "Contact Vs" on ow website at www. jackson.com. Sincerely, ( aura. Lei tie: Laura Hansen VP, Policy Owner Services Jackson Mational Life Tnsarance Company 1 Corporate Way, Lansing, MI 48991 HUUG44-4565 ea ae ut ne Coe. eiecreree Meas □□ = 2020-02-21 11:57 Costco W 130 sign 3236611475 >> FAXCORE == PON □□□ □□ Oe HOS te ara RESTS STRICTO COND OR □ i rae i aha. □ DAG: ie he ie, TH EH 1 iter aI fii ra a At i a IF VTech □□ is) Ci ea hi ie) ti nye es hs ee ah □□ □□□ □ □□ 3 : M3 ti Wee bea Serre oe a piece oh te rere Bt Mee) ips es a +a □□ ae FAP PS ES ON NP meee AE EP TEN, OP VAN RTO NS Ce Sl Ne ey □□□ □□ sear” Oey □□ Seman □□ □□□□ □□ □ moe) ERNEST J. DRONENBURG, JR. =~ □□□ □□□□ ASSESSOR/RECORDER/COUNTY CLERK □□ ee □□□□ te he Me CERTIFICATE OF DEATH 3201837011714 □□ rr tence — □□□ That Eee □□□ □□ na ma □□□ Pea TAILLP ELE LE aT a iices □□ aur □□□□ 5 Lite Coes = LO Ae | CA PORES | a, PRAY pe Pe wt BA Gail een □□□□ cane =| nt aoa we Geer a a Py ea Ga a ve Tm oO ona a | ao Ra Aa ap eT i Te | □□ POSES ST PS Pace ened Pua, oe Mera □□□□□ 3780 VISTA CAMPANA 5 #8 □□ ‘i no Sear ToPanne Ta VERSOTCEMmNTY | Ga WE EOIN Dea □□□□□ Seoseoe ane ee lek Eilromisono.wre «(ROWAN EAMUPAIC Sa SORANERE NERS ae a SE er ae Tannen □□□ RUTH CLARA SCHULTZ □ Tao iain iver ae □□□□ eet oF eS □□□ a arcane dome □□ | RRMeReRORT renee [AnicecrrnC ROSS OMA LINDA UNIV, GOUIES FOR SCIENCE □□□ : Oriaeo18 24780 STEWART ST,, LOMA LINDA, CA 02350 □□ ib rene areas PGunnEE ae wie □□□□ ae □□ ee ean vate! refi ah Eases DOR Pl =? □□ [SARRENTOVALEY Mortuary [Foimes” waumaswooren,wowen §@ [cram ae Th Rane SFR eS = Goan IT re □□ gylwsraraou sreciazencarercume |e Deel Jolin bate Clee Cen ae ar Ear? GL) Eee Se PE SSS ia ory □□□□ areas = = □□□ G309 Seika Sele | See □□ C309 |secoesewtt wALZHEMERS DEMENTIA ers O= be a □□□ a T= Oh re Peer □ □ [eam i [ke □□ Elster. fe □□ A ieee □□□ ‘a (eos □ Teg cr OTR WOO TR TORE CEST - bee □□□□ ae SRRTRSTTE FHETT = a | eer ea cee caer SESE | i Wt ye or 7 OP RUM | cee □□ i] etcmeevie feantnjoe, | PHOUSSAM BAROUDI, MU Soar ln NeeeOIe □□□□ ie 1 ee a eae apy UL LTT TA : MO □□□ Elowenzois joweazois —_—| 1026 VIA CENTRE. VISTA, GA a206t 1. Tho Peal Pie Ciba area BATE, ee AL Pe De eres i c eee wbet a □□□□□□ [acre Juve Come ore Cee Die Coecss |e Oe Om | □□ Deegan capugecoe ee a ee | fu hls NL □□ □□ ar le ar, ce, WT Pa □□□ □□ □□□ SCRE eR TE Te aA ie A i □□□ z= or □□ =. naan This ts a truc and cxact reproduction of the document officially renistered and placed on file in the office of the □□ □ San Diego County Recorder/Clork □□ * * □□ □□□□□ □□□ □□ □□ a if Sin STE □□□ □ □□ att, Sep 21, 2017 Emest J, Dronenburg, Jr. Lire □□□ mo Assessor/Recorder/County Clerk Ha hone □□ tenet NAVINI Fe □□ eet I =, This copy is not valid unfoss propared on an engraved border eae gos □□□ □□□□□□□ alk ‘a a ies displaying date, seal and signotnre of the Recorden'County Clerk O04478428 fea 2 bk □□ □ □□□ artnet Bch omaha □□□ □□□ [a alls oneaa □□□ Tale Mla an al ee alae hae pee ao Cc □□□ 2020-02-21 11:58 Costco W 130 sign 3236611475 >> FAXCORE P 12/38 02/21/2020 15:07:06 : i 2" , i PTTORNET GM Pa OUT ATTORNEY (izaa pgp scaage), (619) 2088 ene □ David M. Huffman HUFFMAN & KOSTAS 4420 Kettner Blvd., Ste. 402 san Diego, CA 92101 : TOME FoR: ELLEN BOND ‘ wnmGIO27 6 SUPERIOR COURT OF CALIFORNIA, COUNTY.OF SAN DIEGO Far □ [3é_] FAMILY COURT BUILDING, 1501-55 SIXTH, SAN DIEGO, CA 92101-1046 = nore COUNTY BRANGH, 325 5. MELROSE, VISTA, CA 92083-8627 EAST COUNTY COURT, 250¢ MAIN, EL CAJON, CA 82020-9013 SEP 2 4 1998 |__| SOUTH BAY COURT, S00 THIRD, CHULA VISTA, CA 21970-4504 MARRIAGE OF By: A. MBYER-JAGQUES, Deputy petitioner, ELLEN A. BOND FAMILY COURT RESPONDENT; PHILIP G. BOND EASE NUMBER; You are notified that the following judgmant was entered on (oote): SFP 7 8 1998 1. GE) Olssotution of Marriage 2 (J Dissotution of Marriage - Status Only . 3. CO Dissolution of Marriage - Rasarying Jurisdiction over Termination of Marital Status 4. Legal Separation 5 Multity 6 Other (epecity): omar gep 24 1088 Kime 6 Waident, KENNETH E. MANTONE CLEAK OF THE SUPERIOR COURT = NOTICE TO ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY - Purgyvant to the provisions of Code of Civil Procedure section 162, if no appeal ls filed the Court may orcer tha exhibits destroyed or otherwise disposed of after GO days from the oxplration of the appeal time. . Effective date of termination of marital atatus (specify): SEP 18 1998 WARNING: NEITHER PARTY MAY REMARRY UNTIL THE EFFECTWE DATE OF THE TERMINATION OFF MARITAL STATUS AS SHOWN IN THIS BOK. CLERK'S CERTIFICATE OF MAILING I certify that | am nota party to this cause and that a true copy of the Notice of Entry of Judgment was mulled first class, postage fully prapald, in a sealed anvelope aderessed as shown below, and that the notice was malled at (place): , California, ETH E, MARTON -. on ae CLERK Of THE GOURT Date: A by 2: , Dapuly ELLEN A. BOND PHILIP G,. BOND a David M. Huffman | a Industry St., Unit B HUFFMAN & KOSTAS Oceanside, CA 92054 1420 Kettner Blvd., Ste. 402 San Diego, CA 92101-2433 Aidell Gouna Caton NOTICE OF ENTRY OF JUDGMENT SUPCTOA21 (Rev. 7-25) Sramy Lam) □ 2020-02-21 11:59 Costco W 130 sign 3236611475 >> FAXCORE P 13/38 02/21/2020 15:07:06. ry THOANEY OF PANTY WITHOUT, ond TELEPHONE Wer FOR COURT LET ae ————_—e (619) 544-0880 David M. Huffman “ * □ HUFFMAN & KOSTAS 1420 Kettner Blvd., Ste. 402 ‘ Ban Diego, CA 92101 69026 BY. t € Dp aronnev (ine): ELLEN BOND when E. MARTONE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO Clark oF thy Sunes Court omcersnores; 1501-55 SIXTH AVENUE 5 □ wuss: P.O. BOX 128 SEP 18 1998 crvwozecoe, SAN DIEGO, CA 92101 onmscn won: EAMT LY LAW DIVISION 304 0? 22 GOULING, Dany □□ MARRIAGE 0 (2? O40 Ist Porer Fee #185..06 PETITIONER: ELLEN A. BOND . responneNt: PHILIP G. BOND JUDGMENT Ce ar Cipescntion [J egal separation _[__) nutty D 495886 □□□ Statue on Jurisdiction over termination of marital status 0) Date marital atatun ends: SEP 7 8 1998 1. This wag hoprd es follows: [__] datauit or uncontostod [31] by declaration under Fam Code, § 2396 (__] contestod □ a. bate: SEP 1 8 1998 Dept: fim: □□ b. Judge (name): William S. Gannon, Judge Cl Temporary judge c. cA Patitionar present In court [J mtorney presant In court (name): dh Hospondent pragent In court Attorney present in court (nama): a. L_] Ctaimant present In court (nome): attornay praesent in court (nama: 2 The court acquired Jurisdiction of tna respondent on (date); 04/27/97 □□ (30) Respondent was sarved with process [__] respondant apposred 4. THE COURT ORDERS, GOOD CAUSE APPEARING: □ a. (3) sudgmant of dissolution be entered. Marital stetueis terminatod and the parties arerestored to tha status of ynmaried persons □ (1) (XJ on the toliowing date (speci): SEP 1 & 1998 (2) LJ on a date to ba datarminad on mothced motion of alther party or on stipulation. □ b. [_] Judgment of egal separation antered c. bef susan of nullity be entered, Tho parties are doclarad to be unmarried persons on the ground of (speclty): Wite's former name be restored (specify; ELLEN A. IFSHILN a, L_] This judgment shall be entered nync pro tunc a of (cate): f. Pa areata if rosorved over al] otter euo9 and all prosent orders ramaln In affect oxcept as provided below. Other (speci); PLEASE SEE ATTACHMENT TO JUDGMENT OF DISSOLUTION WHICH I5 ATTACHED HERETO AND INCORPORATED HEREIN BY REFERENCE. h, Jurisdiction is reserved to make other ordars necessary to carry out this Judgment, Date: □□□□□□□□□□□□□□□□□□□□□□□□□□□ XMXXXXXXKXARERX ARKH JUBGG OF THE SuPERPOR CoouAT 4. Numbor of additional pages attachad: 24 (2271 signature follows tast attachmont P 2 NOTICE □ Ficase reviow your will, Ingurance policies, ratiramant banefit pinna, credit cards, other cradit accounts and credit raporta, and other matters you may want to change In view of the diagolution of annulment of your marriage. or your logal soperation. A dobt or obligation may be assigned to one party a9 part of the division of property and debts, but if that party not pay the debt or obligation, the crogitor may be able to collect from the other party. An carning’ afalgnment wil automatically be lasucd if child aupport, family support, or spousal gyppart ia ordored. Adopted by Rule 1207 JUD@MENT Pansy Code, 240, 203, 205 j 1207 (Rov. January, (Family Law) □ 2020-02-21 11:59 Costco W 130 sign 3236611475 >> FAXCORE P 14/38 is 207:06 i & é MARITAL SETTLEMENT AGREEMENT The parties to this Agreement, PHILIP G. BOND, hereinafter referred to as "Husband", and ELLEN A. BOND, hereinafter referred to as "Wife", agree as follows: 1. STATISTICAL INFORMATION: a. The parties were married on September 17, 1989. bh, There were no children of this marriage. a. Irreconcilable differences have arisen between the parties and these differences have led to an irremediable breakdown - of their marriage. Thus, the parties have separated and agreed to live free from any interference by the other. a. The parties separated on April 18, 1997, which is elght (8) years, six (6) months from the date of their marriage. They have not resumed their marital relationship since the date of separation. e. There is presently on file in the Superior Court of the State of California, County of San Diego, an action for the dissolution of the parties’ marriage filed as Case Number D 435556. The Petition was filed by Wife on April 18, 1997. Husband executed a Notice and Acknowledgement of Receipt on April 27, 1997. The . Notice and Acknowledgement of Receipt which was executed by Husband was filed with the Court on May 13, 1997. 2. PURPOSE OF THIS AGREEMENT: The purpose of this Agreement is to make a final and complete settlement of the parties’ rights and obligations pertaining to: . By Zh PGB E Page 1 of 24 2020-02-21 11:59 Costco W 130 sign 3236611475 >> FAXCORE P 15/38 [0708] MS ® € a. Identification and designation of their respective separate property and separate obligations; b. Identification and division of their community or co-owned property and community or co-owed obligations; ec. Spousal support; and d. Attorney fees. This Agreement also setu forth specific matters over which a Court of competent jurisdiction shall retain jurisdiction. 3. SEPARATE LIVES AND PROPERTY: a. The parties shall live separate and apart and except for the duties and obligations imposed and assumed under this Agreement, each shall be free from interference, authority, and control of the other as fully as though he or she were single and unmarried. Each party may conduct, carry on, and engage in any employment, profession, business, or trade which to him or her may seem advisable for his or her own use or benefit without, and free trom, any control, restraint, or interference, direct or indirect, by the other party and in all respects as if each were unmarried. b. Except as expressly provided to the contraxy in this Agreement, any property acquired by either party from or after the date of separation shall be the sole and separate property of the one acquiring it. Each party waives any and all rights in or to such property and confirms it to be the sole and separate property of the party acquiring it from and after the date of separation. The earnings from personal services of either party after the date of separation shall be the sole and separate property of the one □ acquiring them. PGB □ Page 2 of 24 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 16/38 92/24/2020 35:07:06 : sm c. Except as expressly provided to the contrary in this Agreement, any obligation incurred by either party from or after the date of separation shall be the sole and separate obligation of the party incurring it, and the party shall assume, pay and hold the other party harmless from any obligation so incurred. 4. SPOUSAL SUPPORT: a. Husband's obligation to provide spousal support to - Wife is terminated effective forthwith. b. Wife‘s obligation to provide spotisal support to Husband is terminated effective forthwith. 5. DISCLAIMER OF REPRESENTATION RE VALUR: The parties hereto have acquired various personal and real properties of speculative value. It is understood by the parties that neither party makes any representations to the other as to the value of any property, community or separate, and each party relies on his or her own investigation and judgment with respect to all property and all matters covered by this Agreement. 6, HUSBAND'S SEPARATE PROPERTY: The following assets and/or . obligations are confirmed to Husband as his sole and separate property: a, Husband's clothing, jewelry and personal effects. b. Any bank accounts presently held in Husbands name. c. Husband/s earnings after April 18, 1997, and accumulations thereon. Wife acknowledges that she neither has nor claims any right, title or interest in any such property. Gah GZ Page 3 of 24 . 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 17/38 SOF US "ie é = 7. WIPE'S SEPARATE PROPERTY: The following assets and/or obligations are confirmed to Wife as her sole and separate property: a. Wife's clothing, jewelry and personal effects. b. Any bank accounts presently held in Wife’s name. c. Wife’s aarnings after April 18, 1997, and accumulations thereon. Husband acknowledges that he neither has nor claims any right, title or interest in any such property. 8. DIVISION OF COMMUNITY PROPERTY AND CO-OWNED PROPERTY: a. Husband and Wife hereby divide their community and co-owned property so that the aggregate fair market value of the community and co-owned property received by each is approximately equal, considering the apportionment of any community or joint liabilities. This division is fair and approximately equal, The community or co-owned assets of the parties shall be divided as follows: (1) Assets awarded to Husband. Husband shall receive, as his sole and separate property, the following assets: (a) The household furniture, furnishings and appliances in Husband's possession. (b) One-half (1/2) of the net proceeds from the sale of the real property located at 1425 Glenwood Drive, San Diego, California, 92103. ‘By execution of this Agreement, Husband authorizes Wife's counsel, David M. Huffman, to dishurse the proceeds in his segregated trust account one-half (1/2) to Husband and one-half (1/2) to Wife. Page 4 of 24 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 18/38 2/21/2020 33:07:06 ® (c) The 1984 Cadillac Coupe dé Ville automobile. (d) The 1967 Mercury Cougar automobile. (@) All right, title and interest in Husband’s business known as PME (Price, Manufacturing & Engineering). (2) Assets awarded te Wife. wife shall receive, as her sole and separate property, the following assets; (a) The household furniture, furnishings and appliances in Wife’s possession. (b} One-half (1/2) of the net proceeds from. the sale of the real property located at 1425 Glenwood Drive, San Diego, California, 92103. By execution of this Agreement, Wife authorizes her counsel, David M. Huffman, to disburse the funds in his segregated trust account one-half (1/2) to Husband and one-half - (1/2) to Wife. (c) The 1988 BMW 3251 automobile. (3) Husband has an IRA account with Bank of America, no. Pe which had a balance of $14,940.92 as of March 31, 1997. In order to equalize the division of community assets and debts, Husband shall forthwith transfer the sum of $10,000 from this IRA account into an IRA account in Wife’s name which will be designated by Wife. It is the parties’ intent that the rollover of $10,000 from Husband’s IRA account into an IRA account established by Wife shall constitute a nontaxabie event. If the Internal Revenue Service or the Franchise Tax Board for some . reason attempts to tax this transaction, the Court shall reserve jurisdiction over the allocation of any tax liability, Including ae Gg Page & of 24 2020-02-21 12:00 Costco W 130 sign 3236611475 >> FAXCORE P 19/38 4210708 HL: ® interest and penalties. The remaining balance in Husband's IRA account is awarded to Husband as his sole and saparate property. The $10,000 rolled over into Wife’s new IRA account is awarded to Wife as her sole and separate property. (4) By execution of this Agreement, Husband and Wife each represent to the other that they do not own any interest in any pension plan, profit sharing plan, IRA accounts or any other form of retirement benefits other than those specified in this Marital Settlement Agreement. 9. NO OTHER PROPZRTY: Each party warrants to the other that the warrantor does net own any property of any kind, other than the property set forth in this Agreement. If it later appears that either warrantor now owns any other property and that the warrantee has an interest in that other property, the warrantor shall transfer or pay to the warrantee, at the warrantee’s electloni a. An amount eaqual to the warrantee’s interest in such other property, if it is reasonably susceptible to division; b. The full market value of the warrantee’s interest on the effective date of this Agreement; or c. The full market value of the warrantee’s interest at the time the warrantee discovers the warrantor’s ownership in the property. This Agreement is not intended to impair the availability, in a Court of competent jurisdiction, of any other remedy arising from the undisclosed ownership of any property. 10. AFTER ACQUIRED PROPERTY: Any property acquired by either party from and after the date of this Agreement shall be the sgle Om Zaf PSB E Page 6 of 24 2020-02-21 12:01 Costco W 130 sign 3236611475 >> FAXCORE P 20/38 area ta SS ‘ * * . and separate property of the one so acquiring it; and each of the parties waives any and all property rights in or to such future acquisitions of property as the sole and separate property of the one 0 acquiring the same from the effective date of this Agreement. 11. NO_UNDISCLOBSED GIFwsS: Each party warrants to the other that the Warrantor has not made, without the warrantee’s knowledge and consent, any gift or disposition of community property other than a disposition in exchange for a vaiuabie consideration to the community. If it later appears that the warrantor made a disposition of community property contrary to this warranty, the warrantor shall pay the warrantee one-half (4%) of the fair market value of the community property measured, at the warrantee’s election: a. On the effective date of this Agreement; or b. At the time the warrantee discovers the disposition, less any appreciation in value attributable solely to the acts of the donee(s) and his successor(s),. This Agreement shall not impair the availability, in a Court of competent jurisdiction, of any other remedy arising from the undisclosed disposition of any property. 1i2. OBLIGATIONS: a. Wife shall assume the existing balance owed on the MBNA joan, no. a" in the approximate amount of $18,000. Wife shall use her best efforts to have the existing balance transferred into her name alone. If MBNA refuses to transfer the existing balance into an account in Wife’s sole name, Page 7 of 24 2020-02-21 12:01 Costco W 130 sign 3236611475 >> FAXCORE P 21/38 02/21/2020 15:07:06 yi Wife shall make the payments on this loan in a timely fashion and shall hold Husband harmless from any liability thereon. The □ parties each warrant te the other that there are no other outstanding unsecured debte for which the other may be liable. b. Any liability er obligation incurred at any time by either party and not expressly identified in this Agreement as payable in whole or part by the other party, shall be paid solely by the one incurring the liability or obligation. c. Except as may be expressly provided to the contrary in this Agreement, the party to whom an item of preperty is entirely allocated under this Agreement shall be solely responsible for all obligations incurred at any time relative to such item, including, but not limited to, any encumbrances, taxes and insurance against such item, and, except where otherwise provided in this Agreement, the parties shall be responsible for payment of their proportionate share of all obligations incurred at any time relative to any asset in which the parties both retain interests. d. The party responsible for payment of obligations pursuant to this section shall indemnify and hold the other harmless from all liabilities, costs and expenses relative thereto, including, but not limited to, reasonable attorneys fees and court costs which may be incurred by reason of the necessity to defend any claim or suit brought against the other party to enforce any such obligation. 13. HOLD HARMERSS PROVISION: In the event that a party to | this Agreement is required to pay and hold the other party harmless from some debt, and the party fails to hold the other party ee ay 42 Page 8 of 24 2020-02-21 12:01 Costco W 130 sign 3236611475 >> FAXCORE P 22/38 02/21/2020 15:07:06 "hy = © a and harmless from that debt, then the other party may pay some or all of such debt and deduct said payment from any monies owed by the other party to the party who breached the hold harmless covenant; provided, however, a party shall not pay the debt without first advising the other party of his or her intention to do so and waiting seven (7) days from the date such notice is given; and provided, further, the set off provided shall not be allowed with regard te any claim or demand as to which within said seven (7) day period the other party represents that he or she has a legal defense, unless and until the asserted legal defense is decided or settled adversely to that party. This remedy shall be in addition to any other remedies available for the enforcement of payment of debts. 14. CREDIT HISTORY: The parties agree that the credit history established by them during their marriage shall be deemed to have been the credit history of both parties, notwithstanding practices of creditors and credit reporting agencies which may have reported - such credit history in the name of Husband only or Wife only. Husband agrees ‘that he shall cooperate and execute all such documents as May be reasonably requested by Wife from time to time to enable Wife to provide her prospective creditora with the full eredit history of the parties during their marriage. Nothing herein shall be deemed as creating a liability of Husband for debts ereated by Wife on the basis of credit information obtained as deacribed above. Leg AS B Page 9 of 24 2020-02-21 12:02 Costco W 130 sign 3236611475 >> FAXCORE P 23/38 02/21/2020 15:07:06 ‘ 15. MOTUAL RELEASES: a. Except as otherwise expressly provided in this Agreement, each party releases the other and the other's heire and assigns, from any and all liabilities, debts or obligations and from any and all claims and demands, it being understood that by this present Agreement, Husband and Wife intend to sattle all aspects of their respective property rights or claims arising out of their marital relationship. b. Husband warrants to Wife that he has not incurred, | and he covenants that he shall not incur, any liability or obligation for which Wife is or may be liable, with the exception of any obligations identified in this Agreement. Husband covenants, except as may be expresely provided otherwise in this Agreement, that if any claim, action or proceeding shall hereafter be brought seeking to hold Wife liable on account of any of his debts, liabilities, acts or omissions, he shall, at his sole expense, defend her against any such claim or demand (whether or not well founded) and that he shall indemnify and hold her free and harmless from all costs, expenses and liabilities in connection therewith, including but not limited to, Wife's reasonable attorney fees and costs incurred by reason of the necessity to defend any such claim or suit. : c. Wife warrants to Husband that she has not incurred, and she covenants that she shall not incur, any liability or obligation for which Husband is or may be liable, with the exception of any obligations identified in this Agreement. Wife covenants, except as may be expressly provided otherwise_in this 4g GB & Page 10 of 24 2020-02-21 12:02 Costco W 130 sign 3236611475 >> FAXCORE P 24/38 02/21/2020 15:07:06 tye Agreement, that if any claim, action or proceeding shall hereafter be brought seeking to hold Husband liable on account of any of her debts, liabilities, acts or omissions, she shall, at her sole expense, defend him against any such claim or domand (whether or not well founded) and that she shall indemnify and hold him free and harmless from all costs, expenses and liabilities in connection therewith, including but not limited to, Husband's reasonable attorney fees and costs incurred by reason of the necessity to defend any such claim or suit, 16. SOCIAL SECURITY BENEFITS: The social security benefits of each party which are now or Subsequently declared to be community property, lf any, shall be declared to be the sole and separate property of the party who paid into the fund giving rise to such □ benefits. this Waiver by each party is not intended to prohibit any rights that may be derivative in nature, such as those that arise by virtue of having been married ten (10) or more years. 17. WAIVER OF RIGHTS IN OTHER'S ESTATE: Each of the parties □ waives and renounces any and all rights to inherit the estate of the other at the other’s death, or to receive any property of the other under Will executed before the effective date of this Agreement, or to claim any family allowance or probate homestead from the other’s estate, or to act as axecuter or other personal representative under a Will of the other executed befora the effective date of this Agreement, or to act as administrator, or as administrator with the Will annéxed, of the other’s estate. 18. APVISEMENTS: Each party acknowledges hereby being advised: : We Sf ay Page 11 of 24 2020-02-21 12:02 Costco W 130 sign 3236611475 >> FAXCORE P 25/38 02/21/2020 15:07:06 fig & a. To consider the immediate drafting and examination of a new Will; and b. To review all property rights and employment benefits which have a survivorship or inheritance factor (such as life insurance, pensions, inter vivos trusts, joint tenancy real . and personal property, and bank accounts); and □ To ensure that said Will and said rights and benefits accurately reflect the current desires of such party to this Agreement. 19. RESERVATION OF JURISDICTION: In the Judgment anticipated by this Agreement, there shall be reserved to the San Diego County Superior Court, in addition to the jurisdiction specifically mentioned elsewhere in this inveanant, the jurisdiction to: a. Supervise the payment of any obligation ordered paid or allocated in this Agreement. b. Supervise the division of assets as agreed to herein. ca Supervise the execution of any documents required or reasonably necessary to carry out the terms of this Agreement. d. Supervise the overall enforcement of this Agreement, 20. INCORPORATION OF AGREEMENT: This Agreement in its entirety shall be incorporated inte, made a part of, and merged into the Judgment entered in the pending dissolution of marriage — proceeding. This Agreement is not conditional upon any such incorporation, merger or filing. Husband and Wife shall submit to an order requiring that they carry out and perform each and every “provision of this Agreement on their part to be observed or Oy Sf Page 12 of 24 2020-02-21 12:03 Costco W 130 sign 3236611475 >> FAXCORE P 26/38 25:07:06 □ ® & performed. Provided that the Judgment incorporates this Agreement, the parties further agree that this proceeding may be heard on the default calendar without further notice to either party, on any — date convenient to the Court and may be heard before a pro-tem Judge. 21. WAIVERS AND JODICIAL ACTION: With regard to the Judgment that incorporates this Agreement, the parties waive statements of decision, the right to a new trial, the right to petition for a rehearing, the right te appeal, and any rights under the Seldiers □ and Sailors Civil Relief Act of 1940, as amended. 22. OTHER TERMS AND CONDITIONS : a. Successors: Except as otherwise expressly provided in this Agreement, each and cvery covenant and agreement contained herein ehall inure to the benefit of, and shall be binding on the heirs, legatees, devisees, assignees, administrators, executors and euccessors-in-interest to the parties hereto, but no provision of this Agreement shall ever be deemed or conatrued to be made for the benefit of any person other than the two (2) parties who have executed this Agreement and their respective heirs, legatees, devisees, assignees, administrators, executors and successors-in- □ interest. b. Entire Agreement: This Agreement and any other instrument(s) executed contemporaneously herewith contain the final, complete and exclusive agreement of the parties concerning the subject matters covered. Cc. Effect of Waiver: No waiver of the breach of any terms or provisions of this Agreement shall be or shall be wy ae Page 13 of 24 2020-02-21 12:03 Costco W 130 sign 3236611475 >> FAXCORE P 27/38 45:07:06 ® construed to be a waiver of any preceding or succeeding breach of . the same or any other provision hereof. d. Modification or Termination: This Agreement shall not be altered, amended, modified or terminated except by an instrument in writing executed by both Husband and Wife. Any such agreed alteration, amendment, modification or termination shall be present to the Superior Court for the County of San Diégo, California and shall be incorporated into the Judgment of Dissolution of the parties’ marriage. The parties agree that the Court shall reserve jurisdiction te incorporate such agreed alterations, amendments, modifications or terminations into the Judgment. e. No Third Party Beneficiaries: This Agreement is solely for the respective benefits of Husband and Wife. ft. Unenforceability of Part of the Agreement: Should any section, provision or portion of this Agreement be held to be invalid, illegal, veid or unenforceable, then such section, Provision or portion shall be deleted from this Agreement and it shall be read as though such invalid, illegal, void or unenforceable section, provision or portion was never included and the remainder of: this Agreement, excluding such invalid, illegal, void or unenforceable section, provision or portion, shall nevertheless subsist and continue in full force and effect. g. Applicable Law: This Agreement is entered inte in the State of California and shall be construed and interpreted under and in accordance with the laws of the State of California a ef Page 14 of 24 2020-02-21 12:03 Costco W 130 sign 3236611475 >> FAXCORE P 28/38 2026 FES07 206 hs & @ applicable to agreements made and to be wholly performed in the State of California. h. Representations: Neither of the parties hereto, nor any of his or her representatives, has made any representation or Warranty to the other party upon which the other party is relying in entering into this Agreement, except as herein expressly provided. ' i. Documents and Cooperation: (1) Each of the parties agrees on the request of the other, to execute and deliver any instrument, furnish any information and to perform any other acts reasonably necessary to carry out the provisions of this Agreement without undue delay or expense. A party who fails to comply with this subsection shall reimburse the other party for all cests and expenses, including attorney fees and court costs that, as a result of such failure, become reasonably necessary to carry out this Agreement. Upon a □ party's failure to execute a document reasonably required to carry out the provisions of this Agreement, the parties agree that the court may appoint the County Clerk, upen ex parte application with appropriate notice, as an elisor to sign such documents on behalf of the party who failed to do so voluntarily. This section shall not constitute a waiver of any privilege afforded by law. (2) The party te whom a particular asset is allocated shall pay any recording fee or transfer cost required to evidence the division of property set forth herein. ap Zot PGB E Page 15 of 24 2020-02-21 12:04 Costco W 130 sign 3236611475 >> FAXCORE P 29/38 02/21/2020,15:07:08 tt & : ® (3) For any assets divided in kind, the parties shall share any such fees and costs in the same proportions as the parties hold their interests in such assets under this Aqreement. 3. Captions and Interpretations: The captions of this Agreement are employed solely for convenience and are not to he used as an aid in interpretation. No provision of this Agreement is to be interpreted for or against either party because that party or his or her legal represantative drafted the provision. k. Enforcement of Terms of Agreement - Fees and Costs: Should it be necessary for either party to bring an action in this or any other Court for iin enbéxocnadt of any of the provisions of this Aqreement, the prevailing party in any such action shall be entitled to an award from the other party in any such action of their reasonable attorney fees and costs incurred in any such action. 23, REPRESENTATION BY COUNSEL AND KNOWLEDGE OF AGREEMENT: a. The parties acknowledge that Wife has retained David M. Huffman of the law firm of Huffman & Kostas to advise Wife in connection with the pending dissolution of marriage proceeding and with the negotiations and preparation of this Agreement. By execution of this Agreement, Husband acknowledges that he been advised by David M. Huffman ef his right to seek independent legal counsel and that David M. Huffman cannot and hag not sought to represent Husband at the same time that he is representing Wife, Husband acknowledges by executing this Agreement that he has either obtained independent legal counsel or that he specifically has chosen not to seek the advice of independent leqal counsel. Gf Page 16 of 24 2020-02-21 12:04 Costco W 130 sign 3236611475 >> FAXCORE P 30/38 02/21/2020/15:07:06 th @ @ b. Each party acknowledges and declares that he or she , respectively: (1) Is fully and completely informed as. to the facts relating to the subject matter of this Agreement, and as to the rights and liabilities of both parties; (2) Enters into this Agreement voluntarily, free from fraud, undue influence, coércion or duress of any kind; (3) Has given careful and mature thought to the making of this Agreement; and (4) Fully and completely understands each provision of this Agreement. 24. ATTORNEYS FEES: Husband shall forthwith pay Wife the sun | of $500 as and for reimbursement of Wife’s attorney's fees and eosts incurred in connection with the preparation of the pleadings associated with the pending dissolution proceeding. By execution of this Agreement, Husband acknoWledges that David M. Huffman does not represent Husband in connection with this matter even though Husband has contributed toward Wife's attorney’s fees and costs. 25. REIMBURSEMENT WAIVER: a. Except as may be specifically provided to the contrary in this Agreement, as part of the division of the community property, each party waives all rights to reimbursement for the following: (1) Epstein credits Marriage of Epstein (1979) 24 Cal. 34 76 ) and all rights to reimbursement to which a party may be entitled as a result of the payment of community obligations since the date of separation; PGB EAB Page 17 of 24 2020-02-21 12:04 Costco W 130 sign 3236611475 >> FAXCORE P 31/38 25:07:08 : ts é : (2) Watts credits (In re Marriage of Watts (1985) 171 Cal. App. 3d 366 ) and all rights to reimbursement to which a party or the community may be entitled as a result of one party’s use of community assets since the date of separation; (3) Frick credits [In Re Marriage of Frick (1986) 181 Cal.App. 3d 997 ] and all rights of reimbursement to which a party or the community may be entitled due to one party’s use of community assets for the improvement of separate property during marriage. (4) All rights to reimbursement pursuant to Family Code §2640, or otherwise, for separate property contributed to the acquisition, maintenance or improvement of community property; (5) All rights to reimbursement pursuant to Family Code §2641 or otherwise due the community or a party for contributions made by the community or either of the parties to the . education or training of a party; and, (6) All rights to reimbursement pursuant to Family Cede §915, or otherwise, due the community For payment by the community of a child or spousal support obligation of either party arising from a prior marriage or relationship. b. The reimbursement rights and claims of the parties’ have been taken into consideration in determining any equalizing “payment required by this Agreement. Therefore, these waivers constitute a part of the division of the community estate. 26. TERMINATION OF JOINT TENANCIES: Effective as soon as both parties have signed this Agreement, any and all joint tenancy ewnerships (with rights of direct survivorship) between the parties ay ef i PGB Page 18 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 32/38 02/21/2020,15:07:06 fey « & are terminated. The parties shall own those assets as tenants-incommon. This section applies to all ownerships including, but not limited to, real property, vehicles or institutional accounts. Upon execution of this Agreement and without regard to record title status, each party Waives all rights of direct survivorship from the other party. 27. REPORTING OF INCOME AND INDEMNITY: It shall be the responsibility of cach party to report all income, lesses or □ deductions (or other taxable consequences) to the taxing authorities in a Manner’ consistent with the terms of this Agreement. In the event cither party reports or fails to report income, losses or deductions (or treats the division of property) in a manner inconsistent with the terms of this Agreement, that party shall indemnify the other party for reasonable attorneys and accountants fees, and costs of litigation in defending the reporting required by this Agreement against the other party or taxing authorities. In addition, each party shall indemnify the other for taxes, interest, penalties and other assessmente arising as a result of the reporting of income (or the treating of the © division of property) in a manner inconsistent with the terms of this Agreement. This Section shall apply to all forms of tax returns required by any governmental agency. 28. TAX DOCUMENTATION: a. Each party shall forward to the other a copy of any tax deficiency notice or other correspondence or documentation received from any federal, state or local taxing authority relating to any joint returns filed by Husband and Wife. Each party agrees (oe Lag PGB Page 19 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 33/38 02/21/2020 15:07:06 Eat & & to cooperate fully with the other and to execute any document reasonably requested ‘by the other, and to furnish information and testimony with respect to any tax liability asserted by taxing authorities on any joint return. b. A party shall reimburse the other party for all damages and costs incurred as a result of a party’s failure to abide by the terms of this Section, including reasonable attorney's fees and costs, and accountant’s fees, whether incurred in defending an action by the taxing authorities or in enforcing the provisions of this Saction. . 29. LIABILITY ON PRIOR TAX RETURNS: a. Each party shall pay fifty percent (50%) of all liabilities and expenses, including but not limited to, accounting and leqal fees, relating to any tax liabilities asserted by any federal, state or local taxing authorities arising out of any review of the parties’ personal income tax returns for any period when they filed joint returns. Each party shall, however, be solely responsible for any liabilities and expenses attributalble to a party's intentional misstatement of taxable income or deductions if such intentional misstatement was not known to the other party. b. A party shall reimburse the other party for all damages and costs incurred as a result of a party’s failure to abide by the terms of this Section, including reasonable attorney fees and costs and sacckineast fees, whether incurred in defending an action by the taxing authorities or enforcing the provisions of this Section. . 9 4 : PGB B ' Page 20 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 34/38 MEAP: e 30. MUTUAL WATVER OF EXCHANGE OF FINAL DECLARATION OF DISCLOSURE, SCHEDULE OF ASGETS AND DEBTS AND INCOME AND EXPENSE DECLARATION: Husband and Wife have agreed to waive the preparation and service of final disclosure declarations including Income and Expense Declarations and Schedules of Assets and Debts. This waiver is made in accordance with the provisions of Family Coda Section 2105(c). The parties specifically acknowledge as follows: a. Both parties have complied with Family Code Section 2104 and the Preliminary Declarations of Disclosure have been completed and exchanged. b. Both parties have completed and exchanged current Income and Expense Declarations. c. This waiver is knowingly, intelligently and voluntarily entered into by each of the parties. d. Each party understands that by signing this waiver, he or she may be affecting ‘his or her ability to have the judgment set aside as provided by California law. 31. VEHICLES-HOLD HARMLESS; a. Husband and Wife shall each hold the other free and harmless from the use and operation of any vehicle confirmed or awarded to the respective party. ' b. If any claim, action or proceeding is later brought seeking te hold Wife liable on account of the future use and operation of a vehicle confirmed or awarded to Husband, Husband shall defend, indemnify and hold Wife harmless from all □ liabilities, costs and expenses relative to that claim, including attorneys fees and costs incurred by Wife in defending MH, Lah Page 21 of 24 2020-02-21 12:05 Costco W 130 sign 3236611475 >> FAXCORE P 35/38 — a responding to any collection claim, action or proceeding and any amounts paid by Wife in satisfaction of any judgment or other award. c. If any claim, action or proceeding is later brought seeking to hold Husband liable on account of the future use and operation of a Vehicle confirmed or awarded to Wife, Wife shall defend, indemnify and hold Husband harmless from all llabllities, - costs and expenses relative to that claim, including attorneys fees and costs incurred by Husband in defending or responding to any collection claim, action or proceeding and any amounts paid by Husband in satisfaction of any judgment to other award. Each of us has read this Agreement and is fully aware of its content and its legal effect. THE FORFGOING IS HEREBY AGREED TO BY: DATED: (9-23°7% Ch SEO. Husband,~PHILIP G. ND DATED: 7-13-*% Lisl fed , Wife, ELLEN A. ND os fab PisB EA Page 22 of 24 2020-02-21 12:06 Costco W 130 sign 3236611475 >> FAXCORE P 36/38 02/21/2020 15:07:06 STATE OF CALIFORNIA ) ) ao COUNTY OF SAN DIEGO ) : On Sune ao i998 retore Karen Yoyo —. notary public, personally appearad PHILIP G. BOND, personally to be (or proved to mo on tho basin of oatiofactory evidence) to be the person whove name is sukocrLbod to the within instrument and acknowledge to ma that he executed tha same in hin authorized capacity, and that by hia aiqnature on the inetrument the porson or the entity upon behalf of which the peroon acted, oxacuted the inotrumont. WITNESS; MY HAND OFRICIAL SEAL. ae ects taf), | j eset KAREN HAYWOOD : ( AS AL) kl if idee, Commision # 104057 htural 2 poe Pubic — aba Sa GD) Sees 4) Sat My Goren. Exploos Oct 2. 1798 stale OF CALIEDSMTA ) PE ) eo county’ oF suAreco } ; ; : On l Visitas I LWA nro Cv] lotery public, peroonally appeared E NA. BOND, personally known to be (or proved ta ma on tha ¢ basie of natLofactory evidence) to be the peraon whoaa name le gubeacribed to the within ingtrument and acknowledge to me that she executed the sama in her authorlzed capacity, and that by her signature on tho instrument the person or the entity upon behalf of which the person acted, executed the instrument. WITNESS MY HAND AND OFFICTIAI/ Jean. (olgnature) {oeal) OHATE OF new, \S COUNTY OF ney TORK E ME Neon pote, ota at Mee Vouk : Mo. 31 - 4659357 Qualifiad In New York County yv Commintion Expires Nov. 30, 199 . PGB Leb Page 23 of 24 2020-02-21 12:06 Costco W 130 sign 3236611475 >> FAXCORE P 37/38 020;75 67:08 a @ & caer tae? pgge □□□□□ oe feito ea F + □ WIFE'S ATTORNEY'S CERTIFICATION: «©. □□□ □ The undersigned hereby certifies that he isan attUrney “at law, duly licensed te practice in the ‘state of California, and he has been engaged by ELLEN A. BOND (hereinafter referred to as "Wife"), one of the parties to the foregoing Marital Settlement Agreement; that he has advised and consulted with Wife with respect to her rights and those of Husband and has fully explained to her the legal significance of the Marital Settlement Agreement: and the effect which it has upon her rights. Wife, after being fully advised by the undersigned, acknowledged to the undersiqned that - she fully understood the terms of the Marital Settlement Agreement and its legal effect, and she executed the Marital Settlement Agreement freely and voluntarily. The undersigned has no reason to - believe that Wife did not understand the terms and effects of the Marital Settlement Agreement or that she did not fraely and voluntarily execute the Agreement. No waiver of the attorney-client privilege of confidentiality is intended by this certification. parep: 7-|-4% HUFFMAN & KOSTAS By: Aan A f LDAVID M. HUF Attorneys for Wife PGB ae Page 24 of 24 2020-02-21 12:06 Costco W 130 sign 3236611475 >> FAXCORE P 38/38 02/21/2020 15:07:06 □ i om oH ah, SP sles age ees” | Fee Thx Pam Sti¢har: 2020-02-21 11:54 Costco W 130 sign 3236611475 >> FAXCORE P 3/38 02/21/2020 15:07:06 | Annuity Death Benefit Claim Form J AC K S Oo N° NATIONAL LIFE INSLIRANCR COMPANY Horne Office: Lansing, Michigan Important Instructions for Prompt Settlement www, jackson.com * Use dark ink only to complete this claim form. Print or type. * Claimant must sigh, print hame ahd date the claim form on page 7, * Include a carlified copy of the finalized death carlificate for ihe deceased with manner of passing. If the claimant is a Trustee, please provide a complete copy of the trust agreement, including all amendments and the Trust Tax Identification Number. * If the claimant is an Executor, Administrator, Guardian or other legal representative, please provide a certified copy of the court appointment. * Ifthe claimant is an Attorney-in-Fact on behalf of the beneficiary, include the Power of Attorney instrument. * any of the beneficiaries named in the Contract are deceased, please provide a copy of their death cartificaia. If the claimant |s an ex-spouse, please provide a copy of the divorce decree and proparty settlement agreement. If the claimant is a non-resident alien, please provide the W-8BEN form and Individual Taxpayer Identification Number. DECEASED INFORMATION (please print) Deceased's Name (First) (Middle) _ (Last) Other Name(s) by which Deceased was known Ht) reGoRY | Bod | □ Date of Birth (mm/dd/yy; Date of Death (mm/dd/yy Marital Status of the Deceased C2fISS//I3SE Orfeo & Sd wari [_] Divorced [7] widowed Single Social Security Number of Deceased (IMPORTANT) Contract Number(s) for which you are claiming benefits | a 2/08 | ..d0of¥essi 2 CLAIMANT INFORMATION (please print) Claimant's Name (First Middle Last Claimant's Social Security Number GREGORY | fa SOMO ages Name of Non-natural ™ Claimant (if _ Tax Identification Number Claimant's Physical Address (No P.O. Boxes) City State ZIP Code S06 SORHHOTHA LANE \|CAA YOM COLATR F/3E7 Claimant's Mailing Address Cit State ZIP Code RISE AAMTTH LAalE Enmoyel LitndTay □□□ |\P7387 Date of Birth (mm/dd/yyyy) Relationship tothe Deceased j i Ing area code) □□□ / | SOn/ Claimant's E-Mail Address ce cue cane US Citizen? 1 Yes Oo No TE ress: use [fren Do you wish to take the deceased's Required Minimum Distribution (RMD)? (| Yes [_]No + If no dollar amount is indicated, the RMD will be calculated for you, $ » Note: Please compiete Notice of Withholding on page 3. + This option may only be elected in conjunction with Options A, B, G, D or E, ne Page 1 of 8 Z1142A 03/18 2020-02-21 11:55 Costco W 130 sign 3236611475 >> FAXCORE P 4/38 Gass Seieti One of the Following Options (A, B, C, D or E), Then Sign and Date the Form. A. Lump-Sum Distribution and 5 Year Deferral Options pou seiect this option, you must alow complete the PRR TORENT ASOT ORI Hs an Choose one of the Payment Oplions below: Jackson National Life Insurance Cornpany* (Jackson") will make payment of annuity contract proceeds due you ina luinp-sum, of in increments determined by you wilhin 5 years, 1. Lump-Sum Please send mea check for my proceeds, | | Please wire my proceeds. | acknowledge Ihere will be a $20.00 wire fee and have allached a copy of a voided check. 2, 5-Year Deterral Option |_| elect to withdraw the Death Benefit within five years. | would like to withcrenv $| ___}immediatoly and understand thal | must submil the Annuity Partial or Full Liquidation [tequest, form %3101, lo withdraw the ramainder of the benetil, Please Note: this option is not available for |HAs and other qualified plans if the deceased died ufler lhe HMD beginning diate (generally April 1 after ago 70%). Note: [nh order for any wilhdrawal lo be treated as a dircel exchunge, transter or rollover, you must submit the transferring company's Lellerof Acceptance and required paporwerk, De you wish to advise us that this withdrawal will ba treated as exchange, transter or rollover? [] Yes B, spousal Continuation Option = i you sefect thie option, you mest aie completo Soction F, “Hermficlary Designation.” As the spouse of the deceased, | elect to continue the Contract in my name. Note: It you choose this option you de nat need to ratum Ine Contract lo Jackson If he contract hus the IncomeAccelerator Lifetime Income Beneiit (LIB), iL will lerminate automatically upon election of ie Spousal Continuation Oplion unless you are a covered lite under the LIB with joint option. If you are a covered life under the 116 wilh joint option, he LIB with joint option will remain in effect upon continuation of lhe Contract and may be lerminated independently from the Contract to which It is attached only as allowed by the Termination of the | 1B provigion, it you are coyered under Ihe LIB with joint option, you may set or change the activation date by submilling a completed Activation Forn (44391). Please see Important Information on page 8 for more information regarding the ability to sel, change or cancel the Activation Date, If the contract has the Lite?ay Lifetime Income Rider (LIA), you may clect le tenninate the 1A benctit upon election of ihe Spousal Continuation Option. It you elect fo terminate the LIR, a pro rata LIN Charge will be assessed tor Ihe period since Ihe previous Indexed Option Anniversary, applicable charges will be stopped thereafter and no beretfil will be available. If no lection is mada on the continuation dale, the 1/7 will remain in effect and may be subsequently terminated independently tren the Contract to which it is attached only as allowed by the Termination of tho LIK provision. If you area covered life under the joint benefit, the folnl LIB remain in ettect and may be subsequently lenninaled independontly trom the Gonlract to which it is altached only as allowed by the Tennination of the 11H provision. | elect to continue the LIA. |_|! elect to terminate LIA Page 2 of 8 211424 03/18 2020-02-21 11:55 Costco W 130 sign 3236611475 >> FAXCORE P 5/38 (02/21/2020 15:07:06 _ G Systematic Withdrawal Option = If you welvel this option, you mus! alse complete the “Notico of Withholding” section on page J and Section F, “Bovoficlary Designation.” To authorize direct deposit into your checking or savings uccount, please complete the “Direct Dopoait” section on page 5. If you sefect on Irrevocuale Spstamatic Withdrawal (SW) of Strefch IRA option, no lidexed options will be ovullabte fo pou {if currently opplicadto), und interes! will be credited af o rate bowed on the current and guanonteed Infereat rates duckson credits on fixed anneety colfructs i eurrantiy offers; thet miterest rute moy be heen than tie rofes duckwon oredite fo the Pixie or Fixed Indexed Amnulty. Leslie! a | choose fo take disiribulions over my life expectaniy using Ihe following option: IRA: | choose lo lake distributions over my life expectancy (STRETCH IRA). While you mustlake a minimum amount each year lo salisly IAS requiraments, actditional amounts may be taken al any lime. IF elacted, you may name a beneficiary. If you were to die prior lo recelving all payments, your Duneficiary(ies) may continue any such distributions or lake the current Contract Value as a lump-sum diztnbution. (This option may not be available on all products.) | ]Non-Qualified Annuily:| chouse to take distributions over my life expectancy (ISW). While you must take a minimum arnount cach year lo sulisfy (RS requirements, addilional amounts may ba taken al any time. If clected, you tay name a beneficiary. IF you die prior to receiving all payments, your beneficiary must take the current Contract Value as a lump-sum distribullon, (This option may not be available on all products.) | Spousal Stretch Deferral: | elect lo defar stretch payments at this lime. | understand in the tulure: | must contact the Service Center for tulure distributions. Please select a Mode: |_|Monthly |_| Quarterly [| ]Semi-Annually |_|] Annually Process the first payment as of (mmidd/yyyy) | _| (Calendar days 29, JU, and 31 are not allowed.) □□□ initia! payment date fs nol Inci¢aled, the first payment will begin 30 days afler this form is received by the Claims Scrvive Genler, Notice of With holding — ifyou hove selected opiien A or G, or if you have requested fo lake the deceased's AMD, you must complete this soction, ne Note: Taxes will be withheld if no election is made. Federal Tax Withholding The taxable portion of the distribution made to you will be subject fo 10% (20% for eligible rollover distributions") federal income tax withholding unlass you elect not to have wilhholding apply. po nol withhold federal income tax from my distribution. (lf this box is checked, du nol check box 4 or 3 below.) This option is not avallable tor an eligible rollover distribution trom 403(b) contracts, If you elect not to have wilhhelding apply to your wilhdrawals, or it you de nul have enough withheld, you may be responsible for payment of eslimaled tax. You may incur penallics under ihe eslimaled fax rules If your withholding and estimated tax payinenis are not sufficient 2.| | Withhold 10% (20% for eligible rollover distributions") federal income tax from my distribution. In addition ty the instructions in No. 2 above, please wilhhald the following additional percentage:| | “io State Tax Withholding (Depending on the laws in your state, stale income tax withholding may be required, See "Important Information” section on payy 8 for slate withholding requirements.) _ 4.|_|“Yes,” please withhold the following percentage tor stale income taxes: | |. 5..y')"No," do net withheld slate incume lax. “atl ale pollowee diotributlon fa ony distribution of ull ca ey portion of the balance to the credit of the Owner, Howover, such ofigible rollover usirlbution not inciude: (1) any dritabulyn That i one of a sores of aubatontiolly eyiel padlodic puyments (nothess frequently than annually) ppacte for the fife (or life expectancy) ul ihe Owner of tho joint invos (or joint lite exqpectanuws) of te Quiet ened the Owner's beneticiay, a ture apecilied parlod of tan (10) yours or more, (2) cory dniindyybon iepaire uiie Code Soction [oye (2) any hordehip dratritaullon, end (4) ine portion of tiny dish tution Waal i not included In groga mon, Paga 3al 8 21142A 03/18 2020-02-21 11:55 Costco W 130 sign 3236611475 >> FAXCORE P 6/38 TeO7.0e D. Benefit Continuation Option — □ □□□ scteet this option, you must also complete tho "Notice of Withholding” seation on page 6 and Section F, “Beneficiary Designation.” Ta authorize direct dopoalt Into your checking or savings account, please complete the “Dircot Deposit" section on page 5. sit elect to continue the periodic benefit checks the Annuitant was receiving, E. Income Option Election (Monthly Genetit Must Ge $50 or More.) — if you aeicet one of these options, you must also complete the “Notice of Withholding” section on page & and Secilen F, “Benoficiary Designation.” To authorize direct deposit Inte your checking or savings account, please complete the “Direct Deposit” section on page 5. If an illustration is desired, please contact our office. Income Option A— (Life Only) Equa! payment will be mace to the annuitant as long as he or she is living. Benefits cease al the death of the annuitant, Thera Is no tight to select lump-sum payments for the annuitant and/or owner, Income Option B— (Lite, a - Year Certain) Aterm of ten (10) or 20 years is available. However, a period-cartain may not axtand beyond the life expectancy of the annuitant, Equal payments will be made to the annuilant as long as he or she is living, DEATH BENEFIT: If the annuitant were to die prior to receiving the period-certain payments, any such unpaid payments shall be continued to the designated beneficiary, There is no right to select lump-sum payments for the annuitant and/or owner. [_| Income Option C— (| i Year Term Certain) A period of five through 60 years is available. However, a period-certain may not extend beyond the life expectancy of the annuitant, Equal payments will be made to the annuitant for the specified period of years. DEATH BENEFIT: If the annuitant were to die prior to having received all payments due under this Contract, payments shall be continued for the balance of the period to the beneficiary designated. There is no right to select lump-sum payments for the annuitant and/or owner. “Please send proof of age: either a copy of your birth ceriificats or a copy of your driver's license (or other identification provided by the stale). Benefits will commence upon receipt ol this paperwork in goad order. Frequency of benefit payments: [_] Monthly Quarterly [|] Semi-Annually [__| Annually Page 4.of a 211424 03/18 se a al 2020-02-21 11:56 Costco W 130 sign 3236611475 >> FAXCORE P 7/38 (02/21/2020 15:07:06 | Direct Deposit ~ it you eolected option ©, D, or E, you may authorize diroct doposit by completing this section. | hereby authorize Jackson to direct deposit into lhe chucking or savings account identitied below, until further notice, all contract payments due to the owner of the contract, If the contract Is owned by a irust, [| affirm that | am the current Irustee of the trust and am authorized to make (his request on behalf of the trust, [his authorizalion will remain in eftect until it is revoked in writing, | andor the (rust hareby release and agree to indemnify and hold Jackson harnluss fran any and all claims arising out of or in any way relailed lo Jackson's actions in cormpliance wilh (his aulhorization, | agree thal Jackson Will have no further lability with respect to any payments meade in accordance with this aulhorizalion and may, at any lime, discontinue my direct depusil and Issue checks lo me requiring my personal endorsement. |, for myself, my heirs, execulurs, administrators, and assigns, do heraby consent and agree that any sums of maney cdoposiled lo my account after my dealh shall be refunded to Jackson for distribution to the person or persons, if any, enhiled to those sums under the terms of the contract. (checking Account (tape pre-printed volded check below) * Savings Account (provide letter trom bunk on institution's letterhead; letter must bo signed and dated by a bank representative) * * Direct Deposit will nol be established without receipt of a pre-printed voided check or lettar from your bank. Please nole: Contract payments will gonerata on the day thay are due or the next business day and will be dapasited inte your account within 2-3 business days (racoipl of funds mny bo dolayed by a weekend ur holiday). All paymonts trom custodian owned contracts will be mado payablo tothe Custodian for both dirua duposils and checks. Do not slaple, Do not allach a deposit slip or a starter check. Account Holdor's Mame(a) 245 Main St, Anywhere, USA G0000 Poy To The Order OF — $| _.. et ioollats Your Financial Institutian Vol D Address ———————_State, ZIP 2a Your Transl! fouling Number Your Account Number Your chock umber Payy 5 of 8 Z1142A 03/18 2020-02-21 11:56 Costco W 130 sign 3236611475 >> FAXCORE P 8/38 (02/21/2020-15:07206 Notice of Withholding = i you have sctected option D or E, then you must complete this section. Annuity payments from income options are treated as wages for the purpose of income tax withholding. An annuity payment is one that is included in your income for tax purposes and that you receive in installments at regular intervals over a period of more than one full year from the starting date of the particular investment. The intervals can be annually, semi-annually, quarterly, or monthly. you tell Jackson otherwise, tax must be withheld on annuily payments as if you are married and claiming three withholding allowances, For ahhuity payments, your withholding certificate stays in effect until you changa or revoke it. Jackson must notify you each year of your tight to elect to have no tax withheld or to reveke your election. if you elect not to have withholding apply to your withdrawals, or if you de not have enough withheld, you may be respensible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withhalding and estimated tax payments are not sufficient. Complete the following applicabie lines: You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your payments. {elect notto have state and federal income tax withheld from my pension or annuity. elect withholding from each perlodic pension or annuity payment to be figured using the number of allowances and marital status shown (you may also designate an amount In the box at the right). Number of allowances:| Marital Status: [|Single [_|Maried [_|Martied, but withholding at higher single rate. J i elect the following additional amount withheld from each pension or annuity payment. Notes For annuity payments, you cannot enter an amount here without entering the number (including zero) of allowances above, § | your state of residence has state Income tax, you may elect to have taxes withheld using the same allowances and _ marital status as used for federal withholding. [] | elect to have state tax withheld, (Depending on the laws in Your state, state income tax withholding may be required. See "Important information’ section on page § for state withholding requirements.) F, Beneficiary Designation — if you have selected option A, 3, C, D or E, then you must complete this section, Please name your beneficiary(ies), For additional banaficiarias, plaage attach additional namefs) and requested information on a separate sheet, signed and dated, Primary Yio) Percentage of Death Benefit Name (Firat {Nilecte) {last} ss Date of Birth {mnvagyyyy) ia ser le Lay dod fier ll 72 Entty Name ~~ Tax [dentilication Number Fialallonship to You (nunber, street) Ghy State ZIP Coda Phons Number (includa area coca) actetnerte tiné, \CAuvodcoured ete || M327 _( Page 6 of 8 Z11424 03/18 2020-02-21 11:56 Costco W 130 sign 3236611475 >> FAXCORE P 9/38 (02/21/2020 15:07:06 | 2. {Primary [_] Contingent [ | Percantage of Death Benefit Benonclary’ Namo (Fist) (Mibdig} | Sockygecwty Norbord Non-Matural Entity Marre Tax (dontlication Number aa (number, street) sr State ZIP Coda Phone Nunbor aaroa □□□□ I ia 3, [_]Primary [| Contingent | Percentage of Death Benefit _ | —_e__ Non-Nahural Emiky Mame Tax: idontiflcatiges Number Falationghip io vou | LC] hy ara JF Code Note: All Primary Beneficiary percentages must be in whole percentage numbers that total 100%. All Contingent Beneliciary percentages must also be in whole percentage numbers that total 100%. Ifno beneficiary is elected, your Estate will be recorded, Signature(s) The undersigned hereby makes claim to the undersigned’s share of the death benefit proceeds of he above annully Contract as beneficiary and agrees that the furnishing of this form or any of the forms supplemental thereto by the Company shall not constitute or be considered an admission by the Company thal there was an annuity in force, nor shall it constitute or be considered a waiver of any of the Company's rights or defenses, THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR GONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING. Under penalties of perjury, | certify that: 1. The number shown on this form is my correct Taxpayer Identification Number, 2. | am not subject to backup withholding. 3. | am a U.S. citizen or other U.S, person {including a U.S. resident alien). 4. lam exempt from Foreign Account Tax Compliance Act (FATCA) reporting. By signing balow | acknowledge | have read all options available to me. Please note; ALL ELECTIONS ARE IRREVOCABLE, YOU MAY WISH TO CONTACT A TAX ADVISOR. , New Jersey residents, please note: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Chimant’s Dare mvddyy) Claimants Name (First) (Mode) Ay FA oxfefaso|| crsoer |7> uo (hare ef WW Ereases Gute Sioned (mewayy Wane Makara [Mkicio) sigan ey : “ ee Ueex() Eo Naf lume |e. Boo Page 7 ol 8 21142A 03/18 O_O 2020-02-21 11:57 Costco W 130 sign 3236611475 >> FAXCORE P 10/38 eee epg Important Information - Please Read Carefully eee □□□ en + The entire death banefil mus! be paid within fiva (6) years of the date of death unless you elect to have the death benefit payable under an Income Option or the Systematic Withdrawal Option. The death benefit payable under an Income Option or the Systematic Withdrawal Option must be paid over your lifetime or for a period not extending beyond your life expectancy. + For non-qualified funds, the first IAS-required wilhdrawal under the [SW and Income Option must occur within twelve months of {he owner's death. For Lump-Surm Distributions, non-qualified funds must be completely withdrawn by the fifth anniversary of the date of death, + For qualified funds, the first |R'S-required withdrawal for the Stretch IRA and Income Option must occur by December 31st of the year following the owner's death, For lump-sum distributions qualified funds must be completely withdrawn by December 31 following the fifth anniversary of tha date of death. « If you wish to elect an Income Option or the Systematic Withdrawal Option you must do so within the 60-day period beginning with the date Jackson receives proof of death. Please note: with these options your beneticiary will not receive any enhanced death benefil protections. = Continuation Option is selected fora JNL Target Select * contract, the original allocation period will remain in effect. The Beneficiary will have the option to select a new allocallon perlod upon renewal. + Ploase note: the following states do not have state Income tax. We are not allowed to withhold state tax for these slates: Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington and Wyoming. The following states allow you to elect out of state withholding: California, Delaware, Oregon and Vermont. The state of Georgia allows you to elect out of slafe withholding on benefit payments only. Please note: if you are a Michigan resident, we may be required to withhold state tax al the prevailing fixed percentage. » If you elect to have federal withholding, we are required to withhold for state purposes at the prevailing fixed percentage of the federal rate for the following slates: Arkansas, California, Delaware, Georgia, lowa, Maine, Massachusetts, Mississippi, Nebraska, North Carolina, Oklahoma, Oregon, Vermont and Virginia, + The 10% premature distribution penalty does not apply to distributions made to the beneficiary on or after the death of the original holder of the Contract. + Remember that there are penalties for not paying enough lax during the year, either through withholding or estimated lax payments, New retirees, especially, should see IRS Publication 505, Tax Withholding and Estimated Tax, which can be obtained by contacting the IRS. Publication 505 explains the estimated tax requirements and penalties in detail. You may be able fo avoid quarterly estimated lax payments by having enough tax withheld from your payments, * Please note: if you continue a Contract with a LIB, you may sel or change the Activation Date by completing the Activation Request Form (X4391). lf an Activation Date has been set, you may change or cancel that date by notifying the Company at least 30 days prior to the selected Activation Date. If you do not notify the Company at least 30 days prior to the Activation Date, it cannot be changed or canceled, Mailing Address and Contact Information Jackson Clabns Administration Fegatar ie Overnight Mall 1 Corporate Way, Lansing, MI 48051 Customer Care 836-505-4995 (M-Th: €:00 am. to #00 p.m. ET ond Fri: 8:00 a.m, to 6:00 p.m. ET) Fax* 617-T08-S613 sia ee Gustomercare @pckacn cote a * A lax cover page is not needed. If you have additional instructions to submit please complete Letter of Ingtrection (lorm X4250) including owner and/or annuitant signature(s) 83 applicable, Paga 8 ol 8 211424 03/18 JACKSQN NATIONAL LIFE INSURANCE COMPANY Claims Administration March 14, 2020 Gregory Bond 29506 N Mammoth Lane Canyon Country, CA 91387 Deceased: Philip G Bond Policy No.: 0004865310 Dear Gregory Bond: We are sorry to hear about the death of Philip G Bond and wish to extend our condolences. Based on the information provided, we have established a claim for the following: Policy Number Named Beneficiary Preselected Benefit Option 0004865310 Ellen A Bond Please be aware that it is very important that you provide us with the contact information for the beneficiary(ies) listed above. If this information is not received, it may delay our processing of the claim. In addition, unclaimed funds will be reported to the state as required by law. Please be advised that any scheduled distributions will cease and any un-cashed payments, issued in the deceased's name, have been stopped. In order to process the claim promptly, please return to us the following: * Claim Form * Final Certified Death Certificate Once we receive this information, we will process the claim as quickly as possible. Please be advised, any documentation submitted to our office will not be returned. The State of California Department of Insurance requires that our Company advise you that if you wish to take this matter up with the California Department of Insurance, the telephone numbers for the consumers hotline are 1/800-927-HELP or 213/897-8921. You may write to the California Department of Insurance, Claims Service Bureau at 300 South Spring Street, 11th Floor, Los Angeles, CA, 90013. Jackson National Life Insurance Compan | Corporate Way, Lansing, MI 48951 800/644-4565 Policy Number: 00048653 10 | □ March 14, 2020 If you have any questions or need additional information, please contact our Service Center toll free at 888/565-4995. Sincerely, Muto. Nornoor Laura Hanson VP, Policy Owner Services Enclosure: Claim Form Ji\n LIFE INSURANCE COMPANY 1 Corporate Way Lansing, MI 48954 May 4, 2020 Ellen A. Ifshin 25 Parkview Ave Apt 3K Bronxville NY 10708-2917 Sent via Certified and First-Class Mail RE: Contract Number: 0004865310 Annuitant: Philip G. Bond (deceased) Owner: Focus 2000 Dear Ellen A. Ifshin: : Please accept our sincerest condolences on the death of Philip Bond. We would like you to know that we are available for any questions you may have. At his death, Philip Bond was the annuitant of an annuity issued by Jackson National Life Insurance Company (“Jackson”). A review of our records shows that you remain the recorded beneficiary of the annuity. As of May 4, 2020, the value of the annuity’s death benefit proceeds is $15,174.16. Jackson has received a claim from the annuity’s contingent beneficiary. To proceed with our claim handling, we must know your intentions regarding the annuity. Please tell us by June 1, 2020, whether you intend to claim the annuity’s death benefit proceeds or whether you waive your claim to the annuity’s death benefit proceeds. If you waive your claim to the annuity’s death benefit proceeds, Jackson will pay the proceeds to the contingent beneficiary. You may notify us of your intentions by either (1) calling our Service Center at 888/565-4995, or (2) responding to this letter by completing the below “ELECTION REGARDING CLAIM FOR PROCEEDS?” and returning this letter to Jackson in the enclosed pre-addressed, postage-paid envelope by May 29, 2020. Please keep a copy of the letter with your election marked, Note: if you do not respond to this letter or Jackson receives competing claims to the annuity’s death benefit proceeds, Jackson may be unable to distribute the death benefit proceeds until that dispute is resolved. If you need extra time to make your election, promptly let us know by calling us at 888/5654995. If you have questions about your legal rights, or need legal advice, we recommend you immediately consult a licensed attorney. Variable Products issued by Jackson National Life Insurance Company® and distributed by Jackson National Life Distributors LLC, member NASD. 800/565-8797 Your service needs are very important to us. If you have additional questions or concerns, please contact our Service Center at 888/565-4995, Monday through Thursday, 8:00 a.m. to 7:00 p.m. and Friday 8:00 a.m. to 6:00 p.m. (ET). You may also contact Jackson via email through “Contact Us” on our website at www.jackson.com. Sincerely, Laura Hanson, VP Policy Owner Services ELECTION REGARDING CLAIM FOR PROCEEDS Please mark the appropriate box, sign and date, and return this letter to Jackson in the enclosed pre-addressed, postage-paid envelope by June 1, 2020. I, Ellen A. [fshin: [] CLAIM that I am the proper beneficiary of Philip Bond’s Jackson annuity and I intend to file a claim for the annuity’s death benefit proceeds. L] WAIVE all claim to Philip Bond’s Jackson annuity and consent to Jackson’s payment of the annuity’s death benefit proceeds to the annuity’s contingent beneficiary. Signature Printed Name Date May 4, 2020 □□□ ee titi GREGORY T. BOND 29506 MAMMOTH LANE CANYON COUNTRY CA 91387 RE: Contract Number 0004865310 Annuitant: Philip G. Bond, Deceased To Whom It May Concern: Thank you for submitting Philip Bond’s divorce documents for our review. As you know, Ellen Bond was the annuity’s primary beneficiary at the time of Philip Bond’s passing. Our Legal Department has reviewed the divorce documents you submitted, and it is our opinion that Philip Bond’s divorce from the primary beneficiary did not automatically revoke her designation as beneficiary of the annuity. We ask that you notify us if you disagree with our opinion. We believe that we have located the primary beneficiary using her name supplied in the divorce documents and we are reaching out to her to determine whether she intends to make claim to the annuity’s death benefit proceeds. As of May 4, 2020, the value of the annuity’s death benefit proceeds is $15,174.16. We have asked her to provide us with confirmation of her intent by June 1, 2020, and we will notify you after we receive that confirmation. If Jackson receives competing claims, we may not be able to distribute the death benefit until that dispute is resolved. If you have any additional questions or concerns, visit our website at www.jackson.com to contact Jackson via email or for additional resources. You may also contact our Service Center at 888/565-4995. Sincerely, Cf? Kh, Sonve HMerpsen Laura Hanson, VP Policy Owner Services Contact us: Visit www jackson.com @ 1-800/644-4565 * 24-hour automated service; Service Associates available Monday thru Friday 05/16/2020 09:05:23 | 05/16/2020 09:05:23 Box DCC14044 057980 36 Your service needs are very important to us. [fF you have additional questions or concerns, please contact our Service Center at 888/565-4995, Monday through Thursday, 8:00 a.m. to 7:00 pam. and Friday 8:00 am. to 6:00 p.m. (ET). You may also contact Jackson via email through “Contact Us” on our website at www. jackson.com. Sincerely, Laura Hanson, VP Policy Owner Services ELECTION REGARDING CLAIM FOR PROCEEDS Please mark the appropriate box, sign and date, and return this letter to Jackson in the enclosed pre-addressed. postage-paid envelope by June 1. 20230, I, Ellen A. [fshin: i CLAIM that | am the proper beneficiary of Philip Bond's Jackson annuity and I intend to file a claim for the annuity’s death benefit proceeds. LC] WAIVE all claim to Philip Bond's Jackson annuity and consent to Jackson’s payment of the annuity’s death benefit proceeds to the annuity’s contingent beneficiary. Sten Signature ELLEN A. LESHEN Printed Name _ MAY UM, FORO Date 2020-05-12 10:12 Costco W 130 sign 3236611475 >> FAXCORE P 1/2 05/12/2020 13:12:39 To: Jackson National Life Insurance (Via Fax and Return Mail) Date: May 12, 2020 Re: Policy #0004865310, Philip G. Bond (Annuitant) From: Gregory T. Bond 29506 Mammoth Lane Canyon Country, CA 91387 My name is Gregory T Bond and | am writing to notify you that | disagree with your letter of May 4, 2020 wherein you state that the divorce documents do not automatically revoke Ellen Bond as the primary beneficiary of the above listed annuity. In the event Ellen Bond chooses to attempt to claim this annuity | am specifically contesting that claim. Your letter states that you have given Ellen Bond until June 1, 2020 to stipulate whether she is going to/not going to make an effort to claim this annuity. | would appreciate being notified ifwhen that happens and/or if/when that does not happen. Thank you, Koo Bond Attachment: Jackson National Letter of May 4, 2020 a VE DSU 2O2G 55:19 BOX DCCI4062 058168 2 Annuity Death Benefit Claim Form J AC K S od N? NATIONAL LIFE INSURANCE COMPANY : Home Office: Lansing, Michigan Important instructions for Prompt Settlement www, jacksen,com * Use dark ink only to complete this claim form. Print of type. Claimant must sign, print name and date the claim form on page 7. * Include a certified copy of the finalized death certificate for ihe deceased with manner of passing. * the claimant is a Trustee, please provide a complete copy of the trust agreement, including all amendments and the Trust Tax Identification Number. * If the claimant is an Executor, Administrator, Guardian or ciher legal representative, please provide a certified copy of the court appointment. claimant is an Allorney-in-Fact on behaif of the beneficiary. include the Power of Aftorney instrument. * If any of the beneficiaries named in ihe Contract are deceased, please provide a copy of their death certificate. * If ihe claimant is an ex-spouse, please provide 4 copy of the divorce decree and property seitlement agreement. * ihe claimant is a non-resident alien, please provide the W-3BEN form and Individual Taxpayer Identification Number. DECEASED INFORMATION (please print) Deceased's Name (First) (Middle) (Last) ____ Other Name(s) by which Deceased! was known | Peer (Grecory | BoND Date of Birth (mm/ddfyyyy) _ Date of Death (mm/dd/yyyy) Marital Status of the Deceased io 1S | [ (4 3 Oo oO} fo [der & | YZ Married [ | Divorced [ ]Widowed [| Single Social Security Number of Deceased (IMPORTANT) Contract Number(s) for which you are claiming benefiis | 1. |COOY SES S10 2 | CLAIMANT INFORMATION (please print) Eleimant’s Name (First) (Middle} (Last) — i io! Security Number [eeeexn | Ae gee] Name of Non-natural Entity Claimant (if applicable) □ ___ Tax Identification Number _ Claimant's Physical Address (No P.O. Boxes) City _ __ State ZIP Code } Paawview Ave || BRowxvinte wy lL toes _| Claimant's Mailing Address Gily Static ZIP Gode i APT Bid Date of Birth (mmidd/yyyy) Retationship io the Deceased Daytime Phone Number (including areaccde) hate | ewe eee eT a a eg I po oss Glaimant's E-Mail Address US Cilizen? (Myes Bo you wish to take the deceased's Required Minimum Distribution (RMD)? Nd ves i | No «lf no collar amount is indicated, the RMD will be calculated for you. $ | «Note: Please complete Notice of Withholding on page 3. — « This option may only be elected in conjunction with Options A, B, C, Dor E. Page 1 of 8 21142 03/18 06/01/2020 07:55:19 | Please Select One of the Following Options (A, B, C, D or E), Then Sign and Date the Form. A. Lump-Sum Distribution, Beneficiary Access Account and 5-Year Deferral Options —ir you seiecr this option, you must also complete the “Notice of Withholding” section on page 3. Choose one of the Payment Options Below: (If no settlement option is selected, Jackson National Life Insurance Company * (Jackson®) will contact the beneficiary to seek an affinative selection from the beneficiary.) 1.,Lymp-Sum x Please send me a check for my proceeds. | | Please wire my proceeds. | acknowledge there will be a $20.00 wire fee and have allached a copy of a voided check, 2. Beneficiary Access Account (BAA) | | Please establish an interest bearing BAA in my name for my proceeds and send me a book of checks for access to my money. 3. 5-Year Deferral Option ———— | elect to withdraw the Death Benefit within five years. | would like to withdraw $| | immediately and understand that | must submil the Annuity Partial or Full Liquidation Request, form 43701, to withdraw ihe remainder of the benefit. Please Note: this option is not available for IRAs and other qualified plans if Ihe deceased died afler the RMD beginning date (generally April 1 after age 7O¥2.) Jackson will make payment of annuily contrac! proceeds due you in a lump-sum. Except when contract proceeds are due corporations, partnerships, trusts, estates, minors, and beneficiaries resident in the slate of New York, if the proceeds due you are $5,000 or grealer, you may request {above} thal Jackson establish a BAA in your name thal permits you to write checks to withdraw your money from Ihe BAA. Money in a BAA remains ina Jackson general account until withdrawal. Jackson will pay you inlerest on money in your BAA. Your BAA will not be FDIC-insured. Note: In order for any withdrawal to be treated as a direct exchange, tranafer or rollover, you must submit the transferring company's Leiter of Acceptance and required paperwork. Do you wish to advise us that this wilhdrawal will be treated as a direct exchange, transteror rollover? | | Yes B. Spousal Continuation Option = iryou select this option, you must also complete Section F, “Beneficiary Designation. |] As the spouse of the deceased, | elect to continue the Contract in my name. Note: If you choose this option you do not need to return the Contract to Jackson. If ihe contract has the IncomeAccelerator Lifetime Income Benefit (LIB), it will terminate automatically upon election of {he Spousal Continuation Oplion unless you are a covered life under the LIB with joint option. If you aré a covered life under the LIB with joint option, the LIB with joint option will remain In effect upon continuation of the Contract and may be terminated independently from the Contract to which itis allached only as allowed by the Termination of the LIB provision. If you are a covered life under the LIB with joint option, you may set or change the activation date by submitting a completed Aciivation Form (X4391). Please see Important Information on page 8 for more information regarding the ability to set, change or cancel the Activation Date. lf the contract has the LifePay Lifetime Income Rider (LIF) you may elect to terminate the LIR benefit upon election of the Spousal Continuation Oplion. If you elect to terminate the LIR, a pro rata LIR Charge will be assessed for the period since the previous Indexed Oplion Anniversary, applicable charges will ba stopped therealter and no benefit will be available. |f no election Is made on the continuation date, the LIF will ramain in effect and may be subsequently terminated independently from the Contract to which it is allached only as allowed by the Termination of the LIA provision. If you are a covered life under the joint benetii, the joint LIR remain in effect and may be subsequently terminated independently from the Contract to which il is allached only as allowed by the Termination of the LIF provision, [|| elect to continue the LIR. elect to terminate LIR. Page 2 of 8 21142 03/18 06/01/2020 07:55:19 | oie Lie Hiak fic wit i A Orawan We TO pir 6 A =f you select this option, you must also complete the “Notice af Withholding* section on page 3 and Section F, “Beneficiary Designation.” To authorize direst deposit into your checking or savings account, please complete the “Direct Deposil® section on page 5. if you select an Inevocable Systematic Withdrawal (SW) or Stretch (FA option, no indexed options will be available to you (if currently applicable), and interest will be credited at arate based on the current and guaranteed interes! rates Jackson credils on fixed annuily contracts I. currently offers; that interes! rate may be fess thon ihe rates Jackson credits fo the Fixed or Fixed indexed Annuity. | choose to take distributions over my life expectancy using the following option: IRA; | choose to take distributions over my life expectancy (STRETCH IRA). While you must take a minimum amount each year to satisty IRS requirements, additional amounts may be taken al any time. If elected, you may name a beneficiary. If you were to die prior to receiving all payments, your beneficiary(ies) may continue any such distributions or take ihe current Contract Value as a lump-sum distribution. (This option may not be available on all products.) [| Non-Qualified Annuity: | choose to take distributions over my life expectancy (ISW). While you must take a minimum amount each year to satisfy IRS raquirements, additional amounts may be taken at any time. If elected, you may name a beneficiary. If you die prior to receiving all payments, your beneficiary must take the current Contract Value as a lump-sum distribution. (This option may not be available on all products.) |_| IRA Spousal Stretch Deferral: | elect to defer strech payments at this time. | understand in the future | must contact the Service Center for future distributions, Please select a Mode: [_|Monthly [ |Quarterly [_]Semi-Annually [_] Annually Process the frst payment as of (mmudcyyyy)| ————_—|. (Calendar days 29, 30, and 31 are not allowed.) If an initial payment date is not indicated, ihe first payment will begin 30 days after this form is received by the Claims Service Center, Notice of Withholding — iyou have selected option A or , or if you have requested fo take the deceased's RMD, you must complete this section. Note: Taxes will be withheld if no election is made, Federal Tax Withholding The taxable portion of the distribution made to you will be subject to 10% (20% for eligible rollover distributions") fecleral income tax withholding unless you elect not to have wilhholding apply. 1. Do not withhold federal income tax from my distribution. (If this box is checked, do nol check box 2 or 3 below.) This option is not available for an eligible rollover distribution from 403(b) contracts. If you elect not to have withholding apply to your wilhdrawals, or if you do not have enough withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. weno 10% (20% for eligible rollover distributions") federal income tax from my distribution, 3. | In addilion to the insiructions in No. 2 above, please withhold the following additional percentage: | State Tax Withholding (Depending on the laws in your stale, slate income tax withholding may be required. See “Important Information” section on page 8 for slate withholding requirements.) aX|"ves," please withhold the following percentage for state income taxes:| 5 5. "No," do not withhold stale income tax, “An eligible rollover distribution is any distribution of all or any postion of the balance to the credit of tha Owner, However, such eligible rollover distribution does not inchide: (7) any distribution thatis one of 2 sacins of substantially equal periodic payments (not lees frequanily than annually) made for the life (or We expectancy) of the Owner or tivo joint lives (or joint lifa expectancies) of the Qwnet and the Quiier's beneiiciasy, or for a speciiod period of tan (10) of more; (2) any cistibution required undar Goda Section 401(a)(9); (3) any hardship cisiritution; and (4) the portion of any distribution thatis not included iin gross income. Page 3 of 8 21142 03/18 (06/01/2020 07:55:19 D. Benefit Continuation Option — i you select thie option, you must also complete the "Notice of Withholding” section on page Gand Section F, “Beneficiary Oesignation.” To aulhorize direct deposit into your checking or savings account, please complete the “Direct Ooposit™ section on pages. | elect to continue the periodic benefit checks the Annuitant was receiving. E. Income Option Election (monthly Benetit Must Be $50 or More.) — i you select one of these options, you must also complete the “Nofice of Withholding" section on page 6 and Section F, “Beneficiary Designation.” To authorize direct deposit inlo your checking or savings account, please complete the "Direct Deposit" section on page 5. If an illustration is clesired, please contact our office. ** Income Option A—(Life Only) Equal payment will be made to the annuilant as long as he or she Is living. Benefits cease al Ihe death of the annuitant. There is no right to select lump-sum payments for the annuitant and/or owner. | Income Option B— (Life,| - Year Certain) Aterm of ten (10) or 20 years is available. However, a period-certain may not extend beyond the life expectancy of the annuitant, Equal payments will be made to the annuitant as long as he or she is living. DEATH BENEFIT: If the annuitant were to die prior to receiving the period-certain payments, any such unpaid payments shall be continued fo the designated beneficiary. There is no right to select lump-sum payments for the annuitant and/or owner. [_|Income Option c—(| - Year Term Certain) A period of five through 60 years is available. However, a period-cerlain may nol extend beyond the life expectancy of tha annuilant. Equal payments will be made to the annuitant for lhe specified period of years. DEATH BENEFIT: If the annuitant were to die prior to having received all payments due under this Contract, payments shall be continued for ihe balance of the period to the beneficiary designated, There is no righl to select lump-sum payments for the annuitant and/or owner, **Plaase send proal of age: either a copy of your birth cerliticate or a copy of your driver's license (or other identification provided by the state). Benefits will commence upon receipt of this paperwork In good order. Frequency of benefit payments: [ | Monthly Quarterly [_]Semi-Annually | | Annually Page 4of8 21142 03/18 ssa esses seen ee eee eee EEL □□□ □□ 06/01/2020 07:55:19 | Rece OR ULC R210 Bow 058168 Notice of Withholdi NQ = if you have selected option D or E, then you must complete this section. Annuity payments from income options are ireated as wages for the purpose of income tax withholding. An annuity payment is one that is included in your income for tax purposes and that you receive in instalments at regular intervals over a period of more than one full year from the slarting date of the particular investment. The intervals can be annually, semi-annually, quarierly, or monthly. Unless you tell Jackson otherwise, lax must be withheld on annuity payments as if you are married and claiming three withholding allowances. For annuity payments, your withholding certificate stays in effect until you change or revoke it. Jackson must notify you each year of your right to elect to have no tax withheld or to revoke your election. if you elect not to have withholding apply to your withdrawals, or if you do not have enough withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated lax payments are not sufficient. Complete the following applicable lines: You may be able te avoid quarterly estimated tax payments by having enough lax withheld from your paymients. | elect not to have state and federal income tax withheld from my pension or annuity. | efeet withholding from each periodic pension or annuity payment to be figured using the number of allowances and mariial status shown (you may aiso designate an amount in ihe box af the right). Number of allowances: Marital Status: [| [Single | [Married | {Married, but withholding at higher single rate. i] 1 elect the following addilionat amount withheld from each pension or annuity payment. Nofez For annuity payments, pene you cannot enfer an amount here without entering the number (including zero) of allowances above. $. lf your state of residence has state income tax, you may elect fo have taxes withheld using the same allowances and marital slatus as used for federal wilhholding. | elect to have state tax withheld. (Depending on the laws in your state, state income tax withholcing may be required. See "Important information" section on page 8 for state withholding requirements.) F. Beneficiary Designation — If you fave selected option A, B, C, D or E, then you must complete this section. Please name your bsreficiary(ies), For additional baneficiarias, please attach additional namefs) and requested information on a separate sheel, signed and dated. 1.[__] Primary bo Perceniage of Death Benefit Ce: moe erecta cecr AO arent arm mene aac FEAF SAR Hackl § eee | 1] ~ ELLE. DANIEL aoe MIL |\HESHe TAY -wtfos}r |! ! LoL ee ae 1 | HES a THE | 7 fel | | ES □ □ 5 Non-MaturalEntty Name Tax Identification Number Relationship to You | ae | □□ Son Address (number, strect} City 1 ‘State ZIP Code Phone Number {inckds arsa cote) $< <= 4 Beotwoon fe | Dye Beoow- || KY | 10573 Page 6 of 8 21142 03/18 06/01/2020 07:55:19 | Direct Deposit - you selected option C, D, or E, you may authorize direct deposit by completing this section. | hereby aulhorize Jackson to direct deposil into the checking or savings account identified below, until further notice, all contract payments due to the owner of the contract. If the contract ig owned by a trust, | affirm that | am the current trustee of the trust and am authorized to make this request on behalf of the trust. This authorization will remain in effect uniil itis revoked in writing. | and/or the trust hereby release and agree to indemnify and hold Jackson harmless from any and all claims arising out of or in any way related to Jackson's actions in compliance with this authorization. | agree thal Jackson will have no furiher liability wilh respect to any payments mace in accordance with this authorization and may, al any time, discontinue my direct deposit and issue checks to me requiring my personal endorsement. |, for myself, my heirs, executors, administrators, and assigns, do hereby consent and agree that any sums of money deposited to my account after my death shall be refunded to Jackson for distribution to the person or persons, if any, entilled to those sums under the terms of the contract, Checking Account (lape pre-printed voided check below) * Savings Account (provide letter from bank on institution's letterhead; letter must be signed and dated by a bank representative) * * Direct Deposit will not be established without receipt of a pre-printed voided check or letter from your bank. Please note: Contract payments will generate on the day they are due or the next business day and will be deposited inte your account within 2-3 business days (receipt of funds may be delayed by a weekend or holiday), All payments from custodian owned contracts will ba mada payable to the Custodian for both direct deposits and checks. Do not staple. Do not attach a deposit slip or a starter check. Account Holder's Name(s) 245 Main St. Anywhere, USA 00000 The OrderOt □□ ec ell ~ □□□□□□□□□□□□□□□□□□□□□□□□□□□ oil Tatlars Your Financial Institution □□ VO | D == Name Street Address — Cily, State, ZIP 12354 Your Transit Routing Number Your Account Number Your check number Page 5 of 8 21142 03/18 (06/01/2020 07:55:19 | Receiged OG MPHEARRY 07:55:19 Box DCC14062 O58IBF Contingent | GD | Percentage of Death Benefit Bonefidary's Name fFiret) ANIKI} {last} ____ Date ot Birth (mavcklyyyy) Social Secunty Number | Jonata | Setit | TAs | 69124) 1463 |] Non-Matural Entity Name Tax IGentifeation Number Relationship ip You Pfft sen Address (number, street) City erties State BP Gets Phone Nunijer {include area code Guaesioe «dicey Onl | coos | 3. [4 Primary [| Contingent | Percentage of Beath Beneiit Beneticiany's Name (First), (ice) (Last) Date ot Birth (mmviddiyyyy) Sectal Security Number Non-Natural Entity Name Tax Idantifieation Number Relationship to Yeu (qumber, street) City —_ States Cede Phone Number (inchide area cods) — □□□ □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ Note: All Primary Beneficiary percentages must be in whole percentage numbers thai total 100%. All Contingent Beneliciary percentages must also be in whole percentage numbers that total 100%. lf no beneficiary is alected, your Estate will be recorded. Signature({s) The undersigned hereby makes claim to the undersigned's share of the death benefit proceeds of the above annuily Contract as beneficiary and agrees that the furnishing of this form or any of the forms supplemental thereto by the Company shall not consiituie or be considered an admission by the Company that there was an annuity in force, nor shall it constitute or be considered a waiver of any of the Company's rights or defenses. THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING. Under penalties of perjury, | certify that: 1. The number shown on this form is my correct Taxpayer Identification Number. 2. fam not subject to backup withholding. lama U.S. citizen or other U.S. person {inciuding a U.S. resident alien). 4, 1am exempt from Foreign Account Tax Gompliance Act (FATCA) reporting. By signing below | acknowledge | have read all cptions available to me. Please note: ALL ELECTIONS ARE IRREVOCABLE, YOU MAY WISH TO GONTACT A TAX ADVISOR. Claimant's Signature Daie Signed (mmicktyyyy) Glaimant’s Name (First) (ice) (Last) | Ereente Yul | e5|1s| 2020] ELLEN | FES Hin Signature of Witness Data Sioned (mavedtyyyy) Winese’s Name (Firet) Micile Lasi) yyhal— | oslisl2oe0 | DANIEL | Marte | Tavs ad Page 7 of 8 21142 03/18 06/01/2020 07:55:19 Important Information - Please Read Carefully The entire death benefit must be paid within five (5) years of the date of dealh unless you elect to have the death benefit payable under an Income Option or the Systematic Withdrawal Option. The death benefil payable under an Income Option or the Systematic Withdrawal Option must be paid over your lifetime or for a period not extending beyond your life expectancy. For non-qualified funds, the first |RS-required withdrawal under the ISW and Income Option must occur within twelve months of the owner's death. Far Lump-Sum Distributions, non-qualified funds must be completely withdrawn by the fifth anniversary of the dale cf death. + For qualified funds, the first |RS-required withdrawal for the Stretch IRA and Income Option must occur by December 31st of the year following ihe owner's death, For lump-sum distributions qualified funds must be completely withdrawn by December 31 following the fifth anniversary of the date of death. + If you wish to elect an Income Option or the Systematic Withdrawal Opiion you must do so within the G0-day period beginning with the date Jackson receives proof of death. Please note: with Ihese options your beneficiary will not recelve any enhanced death benefit protections. Continuation Option is selected for a JNL Target Select® contract, the original allocation period will remain in effect. The Beneficiary will have the option to select a new allocation period upon renewal. Please note: the following states do not have state income tax. We are nol allowed to withhold slate tax for these slales: Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington and Wyoming. The following states allow you to elect out of state wilhholding: Califomia, Delaware, Oregon and Vermont. The state of Georgia allows you to elect oul of state withholding on benefit payments only. + Please note: if you are a Michigan resident, we may be required to withhold state tax al the prevailing fixed percentage. = lf you elect to have federal withhokling, we are required to withhold for slate purposes al the prevailing fixed percentage of ihe federal rate for the following states; Arkansas, California, Delaware, Georgia, lowa, Maine, Massachuselts, Mississippi, Nebraska, North Carolina, Oklahoma, Oregon, Vermont and Virginia. * The 10% premature distribution penally does nol apply to distributions made lo the beneficiary on or after the death of the original holder of the Contract. » Remember that there are penalligs for not paying enough tax during the year, elfher through withholding or estimated lax payments. New retirees, especially, should see IRS Publication 505, Tax Withholding and Estimated Tax, which can be oblained by contacting the IRS. Publication 505 explains the estimated tax requirements and penalties in delail. You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your payments. » Please fidte: if you continue a Contract with a LIB, you may set or change the Activation Date by completing the Activation Request Form (X4391). If an Activation Date has been sel, you may change or cancel that date by notifying ihe Company at leas! 30 days prior to the selected Aciivalion Date. If you do not notify the Company al least 30 days prior to the Activation Dates, il cannol be changed or canceled. Mailing Address and Contact Information Jackson Claims Administration Regular Mail P.O. Box 30503, Lansing, Ml 48003-6003 Overnight Mail 1 Coiporata Way, Lansing, MI45351 Customer Care 688-565-6995 (M-Th: 8900 sum, to 7.00 pm. ET and Fi: oem. b600pm.ET) - Fax* 517-708-5513 Enrail customarcare @jackson.com * Afax cover page is not needed. If you have additional instructions to submit please completa Letter of Instruction (form X4259} including owner and/or annuitant signature(s} as applicable, Page 8 of 8 21142 03/18 ee ea ee ag Ee a a en □□□ ee □□□ hae ek emcee, reap ee ee en ed ag ee ee ee Or eg a ta eg ee eee en ee ee □□ □□ □□ □□ □□□□ □□ we . WESHMESTER or:ssiis rue | | | 2h HL IF MAILED it <n IN THE □□□ ‘ch Me JUNITED STATES LES EEE BUSINESS REPLY MAIL cena FIRST-CLASS MAIL PERMITNO.600 LANSING Ml ee POSTAGE WILL BE PAID BY ADDRESSEE EEE ——————= Mofo gtaly ysl puabtatyatyay lf tytyoonf pally JACKSON NATIONAL LIFE INSURANCE COMPANY PO BOX 30503 LANSING MI 48909-9777 | a | 600 Third Avenue, 42nd Floor, New York, NY 10016 « (212) 684-0199 September 10, 2020 se nae 8 ° 212.202.7593 Fax fspano @polsinelli.com VIA ECF The Honorable Nelson S. Roman United States District Court Southern District of New York 300 Quarropas St. White Plains, NY 10601-4150 Re: = Jackson National Life Insurance Co. v. Ellen A. Ifshin, et al. Case No.: 20 Civ. 06930-NSR Dear Judge Roman: I write on behalf of Plaintiff Jackson National Life Insurance Company (“Jackson National”). Jackson National commenced this interpleader action and filed a motion for interpleader deposit on August 27, 2020 (ECF Doc. Nos. 1-6). The action was assigned to Your Honor on August 28, 2020. Due to technical deficiencies in the filing, the motion for interpleader deposit was re-filed on September 2, 2020 (ECF Doc. Nos. 13-14). The interpleader Defendants, Ellen A. Ifshin (“‘Ifshin’) and Gregory T. Bond (“Bond”) have been served with the Complaint and motion for interpleader deposit (ECF Doc. Nos. 15-17). By way of background, on January 3, 1989, Jackson National issued a Flexible Premium Deferred Annuity Policy, bearing Policy Number 0004865310 (the “Annuity’’) to Focus 2000 with Philip G. Bond, deceased being the annuitant (‘Annuitant’). See Declaration of Theresa Thompson at §/ 3 (ECF Doc. No. 13-2). On or around February 21, 2020, Jackson National was provided, among other things, a certificate of death of Annuitant, who died on July 1, 2016, as a resident of San Diego, California. See id. at 95. As of August 12, 2020, the value of the Annuity’s death benefit proceeds is $15,297.56 (the “Proceeds”). See id. at 4 6. The Annuity identifies the primary beneficiary as Ifshin, Annuitant’s ex-wife and the contingent beneficiary as Bond, Annuitant’s son. See id. at ¥ 7. On February 21, 2020, Bond provided to Jackson National an executed claim form, along with a Marital Settlement Agreement between Annuitant and Ifshin. See id. at 8. On March 14, 2020, Jackson National sent correspondence to Bond informing him that Ifshin was the designated polsinelli.com Atlanta Boston Chicago Dallas Denver Houston Kansas City Los Angeles Miami Nashville New York Phoenix St. Louis San Francisco Seattle Silicon Valley Washington, D.C. Wilmington Polsinelli PC, Polsinelli LLP in California September 10, 2020 Page 2 beneficiary of the Annuity. See id. at ¶ 9. On May 4, 2020, Jackson National sent correspondence to Ifshin advising her that she was the named beneficiary under the Annuity and asking her to return an executed claim form if she intended to claim the proceeds of the Annuity by June 1, 2020. See id. at ¶ 10. On May 4, 2020, Jackson National notified Bond that Annuitant’s divorce from Ifshin did not automatically revoke her designation as the beneficiary of the Annuity and asked Bond to notify Jackson National if he disagreed. See id. at ¶ 11. On May 16, 2020, Jackson National received Ifshin’s Election Regarding Claim Proceeds in which she claimed she was the proper beneficiary of the Annuity and intended to file a claim for the Annuity’s death benefit proceeds. See id. at ¶ 12. On May 12, 2020, Bond sent a letter to Jackson National, stating that if Ifshin attempted to claim the Proceeds he would contest her claim. See id. at ¶ 13. On June 1, 2020, Jackson National received from Ifshin an Annuity Death Benefit Claim Form indicating that she elected to claim the Proceeds. See id. at ¶ 14. Jackson National is unable to determine the validity of the conflicting and competing claims to the Proceeds of the Annuity and fears that payment of the Proceeds to any one claimant will subject it to additional liability to the other claimants seeking payment of the Proceeds under the Annuity. Jackson National has no interest in the Proceeds except to the extent such payment discharges any and all obligations Jackson National may owe to any party arising out of the Annuitant’s death and the benefit payable as a consequence thereof under the Annuity. Accordingly, Jackson National filed this statutory interpleader action pursuant to 28 U.S.C. § 1335 as a disinterested stakeholder claiming no interest in the Proceeds of the Annuity. As set forth in Jackson National’s Memorandum of Law in Support of its Motion for Interpleader Deposit (ECF Doc. No. 13.1), in accordance with 28 U.S.C. § 1335 and Fed. R.Civ.P. 67(a), Jackson National requests an order from the Court allowing Jackson National to deposit the Proceeds into the Court’s Disputed Ownership Fund, discharging it from further liability with respect to the Proceeds and the Annuity and dismissing it from this action. In addition, Jackson National requests that pursuant to 28 U.S.C. § 2361 the Court enter an Order restraining and enjoining Defendants from instituting or prosecuting any action in any state or United States Court against Jackson National or its agents and representatives with respect to the Annuity or the Proceeds. Finally, Jackson National requests an order awarding Jackson National its attorneys’ fees and costs to be paid from the Proceeds. Jackson National is a disinterested party that was forced to bring the present suit after competing claims by the ex-wife and son of the Annuitant. September 10, 2020 Page 3 In accordance with Your Honor’s rules, I request that the Court schedule a pre-motion conference, or, in the alternative, set a briefing schedule and hearing date for the motion. Respectfully Submitted, /s/ Frank T. Spano Frank T. Spano FTS:nkw cc: Ellen A. Ifshin Gregory T. Bond From: Frank Spano To: Roman NYSD Chambers Cc: Greg Bond Subject: URGENT Case 7:20-cv-06930-NSR Jackson National Life Insurance Company v. Ifshin Date: Tuesday, November 10, 2020 8:09:05 AM Attachments: image003. png Dear Judge Roman: Please pardon the intrusion. We represent Plaintiff Jackson National Life Insurance Company (“Jackson National”) in this interpleader action. On September 2, 2020, Jackson National filed a motion to (1) deposit the annuity policy death benefit proceeds at issue into the Court’s disputed ownership fund, (2) discharge Jackson National from any further obligations under the policy, and (3) receive an award for its reasonable attorney's fees (ECF Doc. No. 13). On September 10, | wrote to your Honor to request a conference (ECF Doc. No 18). Since that time, Defendant Gregory Bond has consented to Jackson National’s motion, except for the request for attorney’s fees. Defendant Ellen Ifshin has not answered or appeared in the action. We are available at the Court’s convenience to discuss the pending motion or any further steps the Court deems appropriate to resolve the motion. | can be reached at the number indicated below Respectfully submitted, Frank Spano Shareholder fspano @polsinelli.com 212.413.2848 600 Third Avenue New York, NY 10016 □□ OMe recta a ee mee eee) [al POLSINELLI Polsinelli PC, Polsinelli LLP in California polsinelli.com From: NYSD_ECF_Pool@nysd.uscourts.gov <NYSD_ECF_Pool@nysd.uscourts.gov> Sent: Thursday, September 10, 2020 10:58 AM To: CourtMail@nysd.uscourts.gov Subject: Activity in Case 7:20-cv-06930-NSR Jackson National Life Insurance Company v. Ifshin et al Motion for Conference EXTERNAL EMAIL nysd_ecf_pool@nysd.uscourts.gov This is an automatic e-mail message generated by the CM/ECF system. Please DO NOT RESPOND to this e-mail because the mail box is unattended. ***NOTE TO PUBLIC ACCESS USERS*** Judicial Conference of the United States policy permits attorneys of record and parties in a case (including pro se litigants) to receive one free electronic copy of all documents filed electronically, if receipt is required by law or directed by the filer. PACER access fees apply to all other users. To avoid later charges, download a copy of each document during this first viewing. However, if the referenced document is a transcript, the free copy and 30 page limit do not apply. U.S. District Court Southern District of New York Notice of Electronic Filing The following transaction was entered by Spano, Frank on 9/10/2020 at 10:57 AM EDT and filed on 9/10/2020 Case Name: Jackson National Life Insurance Company v. Ifshin et al Case Number: 7:20-cv-06930-NSR Filer: Jackson National Life Insurance Company Document Number:18 Docket Text: FIRST LETTER MOTION for Conference addressed to Judge Nelson Stephen Roman from Frank T. Spano dated September 10, 2020. Document filed by Jackson National Life Insurance Company..(Spano, Frank) 7:20-cv-06930-NSR Notice has been electronically mailed to: Frank Thomas Spano fspano@polsinelli.com, nydocketing@polsinelli.com 7:20-cv-06930-NSR Notice has been delivered by other means to: The following document(s) are associated with this transaction: Document description:Main Document Original filename:n/a Electronic document Stamp: [STAMP dcecfStamp_ID=1008691343 [Date=9/10/2020] [FileNumber=245760000] [7594063a69161974aa5aada7803d9c9b495b7191daf604f186f600295b40e625b9 2834f14a5fb8ee554e27b314c7ca7a26642ab5ae2937dbbbf9eb30a470de16]] This electronic mail message contains CONFIDENTIAL information which is (a) ATTORNEY - CLIENT PRIVILEGED COMMUNICATION, WORK PRODUCT, PROPRIETARY IN NATURE, OR OTHERWISE PROTECTED BY LAW FROM DISCLOSURE, and (b) intended only for the use of the Addressee(s) named herein. 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