DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burlark, Domimic L	DOIID	738588	NAIC NPN	15654115

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	9/30/2010	4/3/2013
Inactive	Non Resident	Agent	Health	9/30/2010	4/3/2013
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	10/15/2010	7/19/2012
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	10/15/2010	7/19/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Health	10/15/2010	7/19/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/15/2010	7/19/2012
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	8/19/2011	12/26/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	8/19/2011	12/26/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	8/19/2011	12/26/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Corporate Call Center, Inc	695480	Agent - Health	3/4/2011	12/26/2012
Inactive	Corporate Call Center, Inc	695480	Agent - Life	3/4/2011	12/26/2012
Inactive	Designated Agent Company Inc.	681257	Agent - Health	10/15/2010	7/19/2012
Inactive	Designated Agent Company Inc.	681257	Agent - Life	10/15/2010	7/19/2012