DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Blake, Lawrence Ray	DOIID	321920	NAIC NPN	7168617

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	4/10/1991	7/1/1998
Inactive	Resident	Agent	Life	4/10/1991	7/1/1998
* 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	Chase Life and Annuity Company	300145	Agent - Health	4/10/1991	12/11/1996
Inactive	Chase Life and Annuity Company	300145	Agent - Life	4/10/1991	12/11/1996
Inactive	Grange Life Insurance Company	300128	Agent - Health	4/11/1991	7/1/1998
Inactive	Grange Life Insurance Company	300128	Agent - Life	4/11/1991	7/1/1998
Inactive	Great Southern Life Insurance Company	301443	Agent - Health	11/6/1995	1/12/1998
Inactive	Great Southern Life Insurance Company	301443	Agent - Life	11/6/1995	1/12/1998
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Health	5/15/1991	3/31/1997
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Life	5/15/1991	3/31/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Tatum Hester & Burkhead Insurance Inc.	399752	Agent - Life	7/9/1993	7/1/1998
Inactive	Tatum Hester & Burkhead Insurance Inc.	399752	Agent - Health	7/9/1993	7/1/1998