DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Anita Marie	DOIID	338825	NAIC NPN	7186567

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Limited Line Credit	5/10/2018		9/30/2025
Inactive	Resident	Agent	Debtors Life	10/17/1997	8/7/2000
Inactive	Resident	Agent	Life	11/13/2001	10/1/2011
Inactive	Resident	Agent	Credit Life & Health	6/16/1995	8/7/2000
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	07/15/2025	09/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American General Assurance Company	300586	Agent - Limited Line Credit	5/7/2001	3/28/2007
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Life	11/28/2006	10/1/2011
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Credit Life & Health	10/17/1997	12/31/1998
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Debtors Life	10/17/1997	12/31/1998
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	5/10/2018	4/11/2024
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	10/23/2008	10/1/2011
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Credit Life & Health	5/11/1999	8/7/2000
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Debtors Life	11/3/1999	8/7/2000
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Limited Line Credit	8/7/2000	8/6/2001
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	12/5/2001	1/7/2006
Inactive	Protective Life Insurance Company	300638	Agent - Life	3/17/2004	11/23/2009
Inactive	Symetra Life Insurance Company	301691	Agent - Life	4/5/2003	7/7/2004
Inactive	Union Fidelity Life Insurance Company	301136	Agent - Credit Life & Health	6/16/1995	8/7/2000
Inactive	Union Fidelity Life Insurance Company	301136	Agent - Limited Line Credit	8/7/2000	2/6/2001
Inactive	Western National Life Insurance Company	300461	Agent - Life	11/13/2001	11/21/2011
Inactive		300277	Agent - Life	3/16/2004	12/15/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Integra Bank National Association	558914	Agent - Life	11/7/2006	10/1/2011
Inactive	Planters Bank Inc	399591	Agent - Limited Line Credit	2/25/2021	3/31/2023