3. That the plaintiff had a valuable interest in the life of the said L. M. at the time of his death, and at the time of effecting the said. insurance. [State nature of the interest.] 4. That on the day of 19 at the said L. M. died [but not by his own hands, or at the hands of justice, etc.], and on the 19 the plaintiff furnished the defend day of ants with proofs of the death of said L. M., and otherwise performed all the conditions of the said policy on [her] part. 5. That no part of the same has been paid, and the said sum is now due thereon from the defendants to this plaintiff. [Concluding part.] FORM No. 715-Interpleader to determine beneficial interest in life insur ance policy. (In Grand Lodge A. O. U. W. v. Miller, 8 Cal. App. 25; 96 Pac. 22.) [Title of court.] The Grand Lodge Ancient Order of United Workmen of Washington, a corporation, plaintiff, V. Ida Miller, and Mark A. Miller, her husband, and Ada Baptist, and Joseph Baptist, her husband, and Ada Baptist, executrix of the last will of Matilda F. Peacock, deceased, defendants. Comes now the plaintiff, and for cause of action complains and alleges: 1. That the plaintiff, Grand Lodge Ancient Order of United Workmen of Washington, is a fraternal beneficiary order, organized and incorporated under the laws of the state of Washington, and authorred to do business in the said state. 2. That the defendants John Doe Miller, whose true Christian name is to the plaintiff unknown, and Ida Miller are husband and wife; that the defendants Richard Roe Baptist, whose true Christian name is to the plaintiff unknown, and Ada Baptist are husband and wife; and that said marital relations existed at all the times hereinafter mentioned; that Ada Baptist is the administratrix of the estate of Matilda Peacock, deceased. 3. That on the 23d day of July, 1892, one William Peacock, being then a resident of the state of Washington, became a member of one of the subordinate lodges of plaintiff and the holder of a beneficiary certificate, by the terms of which the plaintiff agreed to pay to the beneficiary of said William Peacock, upon proof of the latter's death, the sum of $2,000. 4. That the said William Peacock designated as his beneficiary under said beneficiary certificate Matilda Peacock, bearing the relation to him of wife. 5. That the said William Peacock paid all dues and assessments levied against him by plaintiff until the 18th day of April, 1906, when he and his wife, Matilda Peacock, were both instantly killed in the great earthquake disaster of that date, at Santa Rosa, Sonoma County, California; and that there immediately became due from this plaintiff to the beneficiaries of the deceased William Peacock, upon their filing proof of death, the sum of $2,000. 6. That the said William Peacock left surviving him his daughter, Ada Baptist, who was also the daughter of Matilda Peacock, deceased; and the defendant Ida Miller, who was a daughter of said William Peacock by a former wife; that said William Peacock left no other child or children, or issue of any or other child or children. 7. That section 15 of article V of the constitution of the plaintiff, reads as follows: "Sec. 15.-Order of payment to beneficiaries. If one or more of the beneficiaries shall die during the lifetime of a member, the surviving beneficiary or beneficiaries shall be entitled to the benefit equally, unless otherwise provided in the beneficiary certificate, and if all the beneficiaries shall die during the lifetime of the member, and he shall have made no other direction, the benefit shall be to his widow, if living at the time of his death; if he leave no widow surviving him, then said benefit shall be paid share and share alike to his children, his grandchildren living at the time of his death to take the share to which the deceased parent would be entitled, if living; if there be no children or grandchildren of the deceased member living at the time of his death, then said benefit shall be paid to his mother, if living; and if she be dead at the time of his death, then to his father, if living; and if he be dead at the time of his death, then to his sister or sisters, share and share alike; and if he has no sisters living at the time of his death, then to his brother or brothers, share and share alike; and should there be no one living at the death of the member entitled to said benefit under the provisions hereof, then the same shall revert to the beneficiary fund of the grand lodge." 8. That upon proof of the death being filed with the plaintiff, it caused to be issued and sent to be delivered to Ada Baptist and Ida Miller, each as beneficiary of William Peacock, deceased, a draft in the sum of $1,000, and one payable to Ada Baptist and one payable to Ida Miller; that Ada Baptist accepted the draft payable to her, and cashed the same; that the draft payable to Ida Miller was, through a mistake of plaintiff's agent, delivered to Ada Baptist, who claimed the same as the property of the estate of Matilda Peacock, deceased. 9. That the defendants Ida Miller and Ada Baptist claim, and each of them claims, the remaining $1,000, as does also Ada Baptist as administratrix of the estate of Matilda Peacock, deceased; and the plaintiff can not safely pay the same to either of said claimants without an adjudication of the rights of defendants, and plaintiff has been obliged to employ attorneys for that purpose. 10. That the plaintiff herein pays into the clerk of said court the said sum of $1,000. 11. Wherefore, plaintiff prays: That the rights of the defendants in and to the above-mentioned $1,000 be determined, and that the plaintiff be relieved from any and all liability on account of the beneficiary certificate issued to the said William Peacock, deceased; that the plaintiff be absolved and adjudged free from all costs in this action; and for such other and further relief as to the court may seem meet and proper, and for an allowance of attorneys' fees out of said $1,000. Louis F. Hart, and A. A. Sanderson, Attorneys for plaintiff. [Verification.] FORM No. 716-Action on a valued marine policy. [Title of court and cause.] Plaintiff complains of defendant, and for cause of action alleges: 1. That the defendant was at all the times hereinafter mentioned, and now is, a corporation created, organized, and existing under the laws of the state of defendant made to the plaintiff a policy of insurance in writing, upon the ship described in the said policy, which policy is in the words and figures following, to wit: [Insert copy, or annex, and refer to the same as an exhibit.] 3. That said ship was then lying at the port of for a voyage from said port to 4. That on the said port of day of in , preparing 19 the said ship sailed from on the voyage described in said policy, and while proceeding thereon was by the perils of the sea wrecked and totally lost. [Or state other cause of loss.] 5. That the plaintiff was, at the time of the risk, and thereafter, until said loss, the owner of said ship, and was interested therein to an amount exceeding $ namely, in the sum of $ was the value of said ship. day of which 6. That plaintiff duly performed all of the conditions of said policy on his part, and after said loss and destruction of said ship, he gave, on the 19 to the defendant notice and proof of said loss and destruction, and demanded of defendant said sum of $ the amount of said insurance money; but the defendant has not paid said money nor any part thereof, and the whole thereof remains due and unpaid from the defendant to plaintiff. Wherefore, plaintiff prays judgment against defendant for said sum of $ and interest thereon from the 19 and plaintiff's costs of suit. day of [Verification.] A. B., Attorney for plaintiff. FORM No. 717-Complaint on open marine policy. [Title of court and cause.] Plaintiff complains of defendant, and for cause of action alleges: 1. That at all the times hereinafter mentioned the defendant was, and now is, a corporation created, organized, and existing under the laws of 2. That on the premium of $ day of 19 in consideration of the paid to it by the plaintiff, the defendant made to plaintiff a policy of insurance in writing, in the words and figures following, to wit: [Insert copy, or, if preferred, annex, and refer to the same as an exhibit.] 3. That the ship on which said insured property was laden [or was BRA about to be laden] was then lying at the port of a voyage from said port to in 4. That plaintiff was at the time of the commencement of the risk, and at the time of the loss hereinafter mentioned, the owner of the property described in said policy, insured as aforesaid [or the special interest therein insured], and that plaintiff's said interest in said property exceeded the sum of $ ; that the value of said insured property laden on said ship was, when laden, and until the loss thereof hereinafter alleged, $ 5. That on the said day of 19 the said ship sailed from on the voyage described in the policy, and while proceeding thereon all of said insured property so laden on said ship [or the special interest of plaintiff therein insured] was destroyed by the perils of the sea [or state any other cause of loss insured against], to the loss of plaintiff in the sum of $ day of 6. That plaintiff duly performed all of the conditions of said policy on his part, and on the 19, he gave to defendant notice and proof of said loss, and demanded of the defendant the sum of $ the amount of said insurance money, but the defendant has not paid the same, nor any part thereof, and the whole thereof is due and unpaid from the defendant to the plaintiff. Wherefore, plaintiff prays judgment against defendant for the sum of $ [Verification.] A. B., Attorney for plaintiff. FORM No. 718-On vessel lost by perils of the sea. [Title of court and cause.] Plaintiff complains of defendant, and for cause of action alleges: 1. [Averment of incorporation of defendant.] 2. That he was the owner of [or had an interest in] the ship [naming the same] at the time of its insurance and loss, as hereinafter mentioned. day of 19 at 3. That on the , the defendant, in consideration of $ to it paid [or which the plaintiff then promised to pay], executed and delivered to the plaintiff a policy of insurance upon the said ship, a copy of which is hereto attached, marked "Exhibit A," and made a part of this complaint. [Or, whereby it promised to pay to the plaintiff, within Jury's Pl.-86. days after |
