DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Petersen, Martin Deane	DOIID	338450	NAIC NPN	228296

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	4/25/1989	3/31/1997
Inactive	Non Resident	Agent	General Lines	9/24/1990	3/26/1997
Inactive	Non Resident	Agent	Health	4/25/1989	3/31/1997
* 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	Beazley Insurance Company, Inc.	300899	Agent - General Lines	9/24/1990	3/26/1997
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	1/25/1994	3/26/1997
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	4/25/1989	3/31/1997
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	4/25/1989	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	Mutual Of Omaha Marketing Corporation	399970	Agent - Health	6/26/1989	3/26/1997
Inactive	Mutual Of Omaha Marketing Corporation	399970	Agent - Life	6/26/1989	3/26/1997