DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	House, Sherry A	DOIID	349921	NAIC NPN	7191423

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	6/18/1979	3/1/2006
Inactive	Resident	Agent	Health	12/6/1999	3/1/2006
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	5/20/2002	3/1/2006
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	5/20/2002	3/1/2006
Inactive	Chase Life and Annuity Company	300145	Agent - Life	6/18/1979	12/11/1996
Inactive	Continental Casualty Company	301019	Agent - Health	3/24/2000	11/29/2004
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	4/26/2002	6/2/2003
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	4/26/2002	6/2/2003
Inactive	Guarantee Life Insurance Company	301560	Agent - Life	1/21/1997	9/8/2000
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	12/6/1999	7/25/2002
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	12/17/1999	7/25/2002
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	9/8/2000	3/1/2006
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Life	4/1/1996	12/30/1998

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Advanced Health Group, LLC	523817	Agent - Life	5/24/2002	5/31/2005
Inactive	Advanced Health Group, LLC	523817	Agent - Health	5/24/2002	5/31/2005