DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burrell, Charlene Marie	DOIID	687432	NAIC NPN	8943342

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/25/2008	6/30/2010
Inactive	Non Resident	Agent	Life	8/25/2008	6/30/2010
Denied	Non Resident	Life & Health Consultant	Not Applicable
* 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	Symetra Life Insurance Company	301691	Agent - Health	9/4/2008	6/30/2010
Inactive	Symetra Life Insurance Company	301691	Agent - Life	9/4/2008	6/30/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	S B Clark And Assoc Inc	661503	Agent - Health	9/4/2008	6/30/2010
Inactive	S B Clark And Assoc Inc	661503	Agent - Life	9/4/2008	6/30/2010