DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Ann Marie	DOIID	325483	NAIC NPN	7170949

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Credit Personal Property & Unemployment	8/5/1992	12/27/1999
Inactive	Resident	Agent	Life	8/5/1992	12/27/1999
Inactive	Resident	Agent	Health	8/5/1992	12/27/1999
* 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	American Health and Life Insurance Company	300844	Agent - Health	7/1/1999	12/27/1999
Inactive	American Health and Life Insurance Company	300844	Agent - Life	7/1/1999	12/27/1999
Inactive	Balboa Life Insurance Company	301327	Agent - Health	8/5/1992	7/2/1999
Inactive	Balboa Life Insurance Company	301327	Agent - Life	8/5/1992	7/2/1999
Inactive	Tesla Insurance Company	300337	Agent - Credit Personal Property & Unemployment	8/5/1992	7/2/1999
Inactive	Triton Insurance Company	300654	Agent - Credit Personal Property & Unemployment	8/13/1999	12/27/1999

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Avco Financial Services of Kentucky Inc.	399330	Agent - Credit Personal Property & Unemployment	8/28/1998	12/8/1999