DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Empson, Jeramy J	DOIID	771760	NAIC NPN	3527930

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	1/3/2012	6/30/2014
Inactive	Non Resident	Agent	Property	1/3/2012	6/30/2014
Inactive	Non Resident	Agent	Casualty	1/3/2012	6/30/2014
Inactive	Non Resident	Agent	Life	1/3/2012	6/30/2014
* 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	Bristol West Insurance Company	301655	Agent - Casualty	11/21/2012	6/30/2014
Inactive	Bristol West Insurance Company	301655	Agent - Property	11/21/2012	6/30/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	11/21/2012	6/30/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	11/21/2012	6/30/2014
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	2/15/2012	7/24/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Louisvillekentuckyinsuranceinc	648757	Agent - Life	2/15/2012	10/12/2012
Denied	Louisvillekentuckyinsuranceinc	648757	Agent - Health
Denied	Louisvillekentuckyinsuranceinc	648757	Agent - Property
Denied	Louisvillekentuckyinsuranceinc	648757	Agent - Casualty