DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Back, Shirley E	DOIID	350325	NAIC NPN	7191608

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	11/19/1990	1/4/1998
Inactive	Resident	Agent	Health	1/23/1991	1/4/1998
* 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	Anthem Life Insurance Company	301209	Agent - Health	9/3/1996	1/4/1998
Inactive	Anthem Life Insurance Company	301209	Agent - Life	9/3/1996	1/4/1998
Inactive	Golden Rule Insurance Company	301943	Agent - Health	1/23/1991	3/31/1997
Inactive	Golden Rule Insurance Company	301943	Agent - Life	1/23/1991	3/31/1997
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	11/19/1990	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	Arison Insurance Services, Inc.	401001	Agent - Life	6/25/1996	1/4/1998
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/25/1996	1/4/1998