DEPARTMENT OF INSURANCE

Affiliations

Name	Forney, Kenneth Allen	DOIID	607709	NAIC NPN	6524759

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	6/23/2005	7/31/2013
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	National Guardian Life Ins Co (TPA)	605810	Administrator - Not Applicable	3/23/2011	7/31/2013