DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Tillott, Carrie Suzanne	DOIID	650493	NAIC NPN	8475839

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	4/16/2007	4/30/2009
Inactive	Non Resident	Agent	Property	4/16/2007	4/30/2009
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	4/16/2007	4/30/2009
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CLJM LLC	600544	Surplus Lines Broker - Not Applicable	4/30/2007	4/30/2009