DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burden, Shane Phillip	DOIID	641928	NAIC NPN	8942852

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	2/13/2007	11/8/2008
* 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	Jackson National Life Insurance Company	300486	Agent - Life	2/20/2007	6/25/2007
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	2/16/2007	6/25/2007
Inactive	Western National Life Insurance Company	300461	Agent - Life	2/16/2007	7/18/2007
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	2/13/2007	6/20/2007

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Life	2/19/2007	7/18/2007