DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Champlin, Terri Marie	DOIID	502498	NAIC NPN	7211141

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Life	10/24/2017		10/31/2024
Active	Resident	Agent	Limited Line Credit	8/7/2000		10/31/2024
Active	Resident	Agent	Vehicle Physical Damage	6/15/2000		10/31/2024
Denied	Resident	Agent	Health
Inactive	Resident	Agent	Debtors Life	3/6/2000	8/7/2000
Inactive	Resident	Agent	Credit Personal Property & Unemployment	3/6/2000	8/7/2000
Inactive	Resident	Agent	Credit Life & Health	3/6/2000	8/7/2000
* 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	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Health and Life Insurance Company	300844	Agent - Credit Life & Health	3/6/2000	8/7/2000
Inactive	American Health and Life Insurance Company	300844	Agent - Debtors Life	3/6/2000	8/7/2000
Denied	American Health and Life Insurance Company	300844	Agent - Health
Inactive	American Health and Life Insurance Company	300844	Agent - Life	10/24/2017	4/12/2023
Inactive	American Health and Life Insurance Company	300844	Agent - Limited Line Credit	8/7/2000	4/12/2023
Inactive	Merit Life Insurance Co.	300150	Agent - Life	6/20/2018	12/12/2018
Inactive	Merit Life Insurance Co.	300150	Agent - Limited Line Credit	9/14/2016	12/12/2018
Inactive	Triton Insurance Company	300654	Agent - Credit Life & Health		8/7/2000
Inactive	Triton Insurance Company	300654	Agent - Credit Personal Property & Unemployment	3/6/2000	8/7/2000
Inactive	Triton Insurance Company	300654	Agent - Limited Line Credit	8/7/2000	4/12/2023
Inactive	Triton Insurance Company	300654	Agent - Vehicle Physical Damage	6/15/2000	4/12/2023
Inactive	Yosemite Insurance Company	301519	Agent - Limited Line Credit	9/14/2016	1/23/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Interstate Agency Inc	610890	Agent - Limited Line Credit	8/10/2018	2/21/2019
Inactive	Interstate Agency Inc	610890	Agent - Life	8/10/2018	2/21/2019
Inactive	Onemain Assurance Services LLC	751094	Agent - Limited Line Credit	7/26/2018	4/12/2023
Inactive	Onemain Assurance Services LLC	751094	Agent - Life	6/20/2018	4/12/2023