DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Queen III, Greenville Burton	DOIID	733543	NAIC NPN	15873592

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	8/16/2010	7/1/2012
Inactive	Resident	Agent	Life	8/16/2010	7/1/2012
Inactive	Resident	Agent	Casualty	1/31/2011	7/1/2012
* 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	Bankers Life and Casualty Company	300701	Agent - Health	8/16/2010	9/15/2010
Inactive	Bankers Life and Casualty Company	300701	Agent - Life	8/16/2010	9/15/2010
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Health	8/16/2010	9/15/2010
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Life	8/20/2010	9/15/2010
Inactive	Coventry Health and Life Insurance Company	301771	Agent - Health	9/21/2010	7/1/2012
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	9/21/2010	7/1/2012
Inactive	Midland National Life Insurance Company	300923	Agent - Health	9/27/2010	7/1/2012
Inactive	Midland National Life Insurance Company	300923	Agent - Life	9/27/2010	7/1/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Alliance Assurance Agency Ltd.	401003	Agent - Health	9/21/2010	7/1/2012
Inactive	Alliance Assurance Agency Ltd.	401003	Agent - Life	9/27/2010	7/1/2012
Inactive	Medlink Inc	400721	Agent - Health	11/5/2010	7/1/2012
Inactive	Medlink Inc	400721	Agent - Life	11/5/2010	7/1/2012