DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Tony E	DOIID	333771	NAIC NPN	7182349

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	1/23/1997	7/1/2002
Inactive	Resident	Agent	Limited Line Credit	8/7/2000	5/31/2006
Inactive	Resident	Agent	Credit Life & Health	9/13/1996	8/7/2000
* 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	Banc One Kentucky Insurance Company	300824	Agent - Credit Life & Health	9/13/1996	9/15/1998
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Credit Life & Health	7/29/1999	8/7/2000
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	8/7/2000	5/31/2006
Inactive	Keyport Life Insurance Company	300319	Agent - Life	2/13/1997	5/19/1999
Inactive	Life Investors Insurance Company of America	301793	Agent - Life	2/3/1997	7/1/2002
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	1/23/1997	7/1/2002
Inactive	Security Benefit Life Insurance Company	300583	Agent - Life	12/13/1999	7/1/2002
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	2/16/1999	7/1/2002
Inactive	Western National Life Insurance Company	300461	Agent - Life	12/21/1999	7/1/2002
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	12/28/1999	7/1/2002

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Life	10/19/2000	7/1/2002