DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Staci Lyn	DOIID	517654	NAIC NPN	7215509

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	3/16/2006	9/30/2007
Inactive	Resident	Agent	Life	3/16/2006	9/30/2007
Inactive	Resident	Agent	Limited Line Credit	11/6/2000	9/30/2005
* 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	Everlake Life Insurance Company	300873	Agent - Life	3/1/2005	9/30/2005
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	11/6/2000	9/30/2005
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	3/31/2006	7/28/2006
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	3/28/2006	8/31/2006
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	4/5/2006	8/17/2006
Inactive	Western National Life Insurance Company	300461	Agent - Life	3/27/2006	8/22/2006
Inactive	Western-Southern Life Assurance Company	301590	Agent - Health	3/27/2006	7/28/2006
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	3/27/2006	7/28/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Life	3/27/2006	8/31/2006
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Health	3/27/2006	7/28/2006