DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Kloock, Mary R	DOIID	626731	NAIC NPN	2160884

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	2/24/2006	10/31/2011
Inactive	Non Resident	Agent	Casualty	2/24/2006	10/31/2011
Inactive	Non Resident	Agent	Health	2/24/2006	10/31/2011
Inactive	Non Resident	Agent	Life	2/24/2006	10/31/2011
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	9/20/2007	6/23/2008
* 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	4 Ever Life Insurance Company	301307	Agent - Health	5/22/2006	4/14/2008
Inactive	4 Ever Life Insurance Company	301307	Agent - Life	5/22/2006	4/14/2008
Inactive	BCS Insurance Company	300294	Agent - Casualty	5/22/2006	4/11/2008
Inactive	BCS Insurance Company	300294	Agent - Property	5/22/2006	4/11/2008
Inactive	Employers Insurance Company of Wausau	301813	Agent - Casualty	8/22/2006	4/22/2008
Inactive	Employers Insurance Company of Wausau	301813	Agent - Property	8/22/2006	4/22/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Seabury & Smith Inc	394854	Agent - Life
Denied	Seabury & Smith Inc	394854	Agent - Health
Denied	Seabury & Smith Inc	394854	Agent - Property
Denied	Seabury & Smith Inc	394854	Agent - Casualty