DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Jacobs, Tiffany D	DOIID	612344	NAIC NPN	8524725

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/5/2014	12/31/2015
Inactive	Non Resident	Agent	Life	9/5/2014	12/31/2015
Inactive	Non Resident	Agent	Limited Line Credit	7/20/2007	9/8/2009
* 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	CMFG Life Insurance Company	300929	Agent - Health	9/9/2014	5/23/2015
Inactive	CMFG Life Insurance Company	300929	Agent - Life	9/9/2014	5/23/2015
Inactive	CMFG Life Insurance Company	300929	Agent - Limited Line Credit	7/20/2007	9/8/2009
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/28/2009	4/14/2010
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	10/28/2009	12/31/2011
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/28/2009	4/14/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Park Community Credit Union	525931	Agent - Limited Line Credit	3/9/2007	6/21/2007