DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Keller, Kirk Douglas	DOIID	378120	NAIC NPN	235848

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	6/10/1999	7/31/2003
Inactive	Non Resident	Agent	Health	6/10/1999	7/31/2003
* 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	Liberty Life Insurance Company	301542	Agent - Health	4/4/2002	7/31/2003
Inactive	Liberty Life Insurance Company	301542	Agent - Life	4/4/2002	7/31/2003
Inactive	Reassure America Life Insurance Company	301902	Agent - Health	11/19/2001	7/31/2003
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	11/19/2001	7/31/2003
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	6/10/1999	9/24/2001
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	6/10/1999	9/24/2001

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Financial Insurance Services, Inc.	514710	Agent - Life	9/14/2001	10/15/2001
Inactive	Financial Insurance Services, Inc.	514710	Agent - Health	9/14/2001	10/15/2001