DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Blackburn & Ward Funeral Home Inc	DOIID	398957	NAIC NPN	7221300

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Life	2/16/2017		3/31/2025
* 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	01/15/2025	03/31/2025

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 - Life	2/2/1998	5/19/2005
Inactive	Forethought Life Insurance Company	301407	Agent - Life	5/9/1997	5/1/2008
Inactive	Great Western Insurance Company	501693	Agent - Life	7/28/2020	7/12/2021
Active	Homesteaders Life Company	300836	Agent - Life	2/22/2017
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	6/3/1997	1/3/2003
Active	Southern Financial Life Insurance Company	300664	Agent - Life	7/12/2021
Inactive	Union Security Insurance Company	301844	Agent - Life	8/19/2002	9/13/2006

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Baker, Penny J	943209	Agent - Life	2/21/2017
Inactive	Miller, James Kent	312753	Agent - Life	5/9/1997	8/20/1999
Inactive	Trent, Beckie Ann	539078	Agent - Life	1/7/2004	11/30/2006
Inactive	Ward, James Steve	333523	Agent - Life	5/9/1997	2/29/2008