DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Cathy Jo	DOIID	310272	NAIC NPN	812260

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	11/11/1996	7/31/2003
Inactive	Non Resident	Agent	Life	11/11/1996	7/31/2003
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Health	11/11/1996	3/19/2001
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Life	11/11/1996	3/19/2001
Inactive	Veterans Life Insurance Company	300589	Agent - Health	11/11/1996	1/5/1998
Inactive	Veterans Life Insurance Company	300589	Agent - Life	11/11/1996	1/5/1998
Inactive	Wilcac Life Insurance Company	301573	Agent - Health	5/8/2001	7/31/2003
Inactive	Wilcac Life Insurance Company	301573	Agent - Life	5/8/2001	7/31/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	TeleSpectrum, Inc	512199	Agent - Life	7/31/2000	6/10/2002
Inactive	TeleSpectrum, Inc	512199	Agent - Health	7/31/2000	6/10/2002