DEPARTMENT OF INSURANCE

Affiliations

Name	Mountain Lakes Insurance	DOIID	1395035	NAIC NPN	21556221

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	4/15/2025	3/31/2027
Active	Non Resident	Agent	Health	4/15/2025	3/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bookout, Tabatha Marie	653947	Agent - Health	4/15/2025
Active	Bookout, Tabatha Marie	653947	Agent - Life	4/15/2025