DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Pettitt, Mark J	DOIID	554533	NAIC NPN	1029486

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/19/2002	7/31/2005
Inactive	Non Resident	Agent	Life	8/19/2002	7/31/2005
* 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	Humana Health Plan, Inc.	300142	Agent - Health	8/19/2002	7/31/2005
Inactive	Humana Insurance Company	301104	Agent - Health	8/19/2002	7/31/2005
Inactive	Humana Insurance Company	301104	Agent - Life	8/19/2002	7/31/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Preferred Benefits Services Agency, Inc.	524664	Agent - Health	3/3/2003	5/31/2005
Inactive	Preferred Benefits Services Agency, Inc.	524664	Agent - Life	3/3/2003	5/31/2005