DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Blake, Debra P	DOIID	680216	NAIC NPN	2829115

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	5/12/2008	5/31/2012
Inactive	Non Resident	Agent	Life	5/12/2008	5/31/2012
* 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	Hartford Life and Accident Insurance Company	300878	Agent - Health	9/10/2008	6/30/2012
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	9/10/2008	6/30/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CBIZ Benefits & Ins Services Inc	514101	Agent - Life	9/10/2008	7/29/2010
Inactive	CBIZ Benefits & Ins Services Inc	514101	Agent - Health	9/10/2008	7/29/2010