DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Von Mizener, Jeremy David	DOIID	719319	NAIC NPN	14656679

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	12/8/2009	9/30/2015
Inactive	Non Resident	Agent	Property	12/8/2009	9/30/2015
* 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	National Casualty Company	301483	Agent - Casualty	1/27/2010	4/2/2015
Inactive	National Casualty Company	301483	Agent - Property	1/27/2010	4/2/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	DVM Insurance Agency	636779	Agent - Casualty	5/7/2014	4/2/2015
Inactive	DVM Insurance Agency	636779	Agent - Property	5/7/2014	4/2/2015