DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Jacobs, Bethany Paige	DOIID	630032	NAIC NPN	7947994

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	4/12/2006	8/31/2008
Inactive	Non Resident	Agent	Casualty	4/12/2006	8/31/2008
* 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	Old Republic Insurance Company	301225	Agent - Casualty	10/5/2007	8/31/2008
Inactive	Old Republic Insurance Company	301225	Agent - Property	10/5/2007	8/31/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Falcon Ins Agency Midwest Inc	605927	Agent - Property	10/29/2007	2/14/2008
Inactive	Falcon Ins Agency Midwest Inc	605927	Agent - Casualty	10/29/2007	2/14/2008