DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Larry Wayne	DOIID	347609	NAIC NPN	1502870

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Debtors Life	9/29/1999	8/7/2000
Inactive	Resident	Agent	Limited Line Credit	8/7/2000	8/31/2015
Inactive	Resident	Agent	Credit Life & Health	7/20/1993	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	Investors Heritage Life Insurance Company	300363	Agent - Credit Life & Health	2/20/1996	8/7/2000
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	1/8/2007	8/31/2015
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Credit Life & Health	11/24/1998	8/7/2000
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Debtors Life	9/29/1999	8/7/2000
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Limited Line Credit	8/7/2000	1/7/2008
Inactive	National Guardian Life Insurance Company	300596	Agent - Credit Life & Health	7/20/1993	12/1/1998
Inactive	Southern Financial Life Insurance Company	300664	Agent - Credit Life & Health	10/1/1998	8/7/2000
Inactive	Southern Financial Life Insurance Company	300664	Agent - Debtors Life	2/28/2000	8/7/2000
Inactive	Southern Financial Life Insurance Company	300664	Agent - Limited Line Credit	8/7/2000	8/31/2015
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Credit Life & Health	11/17/1995	9/25/1998

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Farmers & Traders Bank of Campton	399393	Agent - Limited Line Credit	10/7/2004	8/31/2015
Inactive	Farmers State Bank	399392	Agent - Limited Line Credit	1/23/2007	8/31/2015
Inactive	Peoples Exchange Insurance	400296	Agent - Credit Life & Health	6/25/1997	8/7/2000
Inactive	Peoples Exchange Insurance	400296	Agent - Limited Line Credit	8/7/2000	2/13/2003