DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burchett, Cortney	DOIID	642475	NAIC NPN	8915051

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	3/11/2008	11/30/2011
Inactive	Non Resident	Agent	Casualty	3/11/2008	11/30/2011
Inactive	Non Resident	Agent	Personal Lines	3/11/2008	11/30/2011
* 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	Nationwide Assurance Company	300166	Agent - Personal Lines	11/15/2006	7/26/2007
Inactive	Nationwide General Insurance Company	300603	Agent - Personal Lines	11/15/2006	7/26/2007
Inactive	Nationwide Mutual Fire Insurance Company	301722	Agent - Personal Lines	11/15/2006	7/26/2007
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Personal Lines	11/15/2006	10/12/2007
Inactive	Nationwide Property and Casualty Insurance Company	300599	Agent - Personal Lines	11/15/2006	7/26/2007

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Personal Lines	2/28/2007	10/12/2007
Denied	Seabury & Smith Inc	394854	Agent - Personal Lines
Denied	Seabury & Smith Inc	394854	Agent - Property
Denied	Seabury & Smith Inc	394854	Agent - Casualty