DEPARTMENT OF INSURANCE

Affiliations

Name	Administrative Information Management Inc.	DOIID	401276	NAIC NPN	7223006

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Administrator	Not Applicable	3/27/1989	3/31/2009
Inactive	Resident	Agent	Life	10/8/2010	3/31/2013
Inactive	Resident	Agent	Variable Life and Variable Annuities	10/8/2010	3/31/2013
Inactive	Resident	Agent	Health	4/3/1996	3/31/2009
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	5/6/1997	3/31/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	5/6/1997	3/31/2009
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	4/19/1999	7/17/2000
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	4/19/1999	7/17/2000
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	4/3/1996	3/31/2009
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	11/11/2010	3/31/2013
Inactive	Nationwide Life Insurance Company	300495	Agent - Variable Life and Variable Annuities	11/11/2010	3/31/2013

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Clark, Lawrence Scott	320420	Agent - Health	4/3/1996	9/11/2001
Inactive	Clark, Lawrence Scott	320420	Agent - Life	4/3/1996	9/11/2001
Inactive	Leonberger, Marion Leopold	391426	Agent - Health	4/3/1996	3/31/2009
Inactive	Leonberger, Marion Leopold	391426	Agent - Life	10/8/2010	3/31/2013
Inactive	Leonberger, Marion Leopold	391426	Agent - Variable Life and Variable Annuities	10/8/2010	3/31/2013
Denied	Smith, Chester Duane	332374	Administrator - Not Applicable
Inactive	Smith, Chester Duane	332374	Agent - Health	4/3/1996	3/31/2009
Inactive	Smith, Chester Duane	332374	Agent - Life	4/3/1996	3/31/2009
Inactive	Smith, Chester Duane	332374	Agent - Variable Life and Variable Annuities	3/23/2001	3/31/2009
Inactive	Smith, Evangeline S	389685	Administrator - Not Applicable	6/11/1993	3/31/2013