DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Brett Justin	DOIID	608795	NAIC NPN	8471301

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Denied	Resident	Agent	Property
Denied	Resident	Agent	Casualty
Inactive	Resident	Agent	Life	6/22/2005	1/31/2008
Inactive	Resident	Agent	Health	7/18/2006	1/31/2008
* 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	American Fidelity Life Insurance Company	301282	Agent - Life	7/26/2005	7/17/2006
Inactive	Columbian Life Insurance Company	300810	Agent - Life	7/14/2006	1/31/2008
Inactive	Government Personnel Mutual Life Insurance Company	301862	Agent - Life	8/3/2005	10/11/2007
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	12/4/2006	6/29/2007
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	10/4/2006	7/2/2007
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	10/4/2006	7/2/2007
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Health	10/4/2006	4/2/2007
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Life	10/4/2006	4/2/2007
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	4/2/2007	1/31/2008
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	4/2/2007	1/31/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	McConnell Insurance Agency Inc.	400140	Agent - Life	8/31/2006	1/31/2008
Inactive	McConnell Insurance Agency Inc.	400140	Agent - Health	10/4/2006	1/31/2008
Inactive	McKinney Insurance Services, Inc.	584578	Agent - Life	4/19/2006	1/24/2007