DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Domino, Michelle M	DOIID	802218	NAIC NPN	9598277

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/28/2022		3/31/2026
Active	Non Resident	Agent	Life	9/28/2022		3/31/2026
* 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	Combined Insurance Company of America	301472	Agent - Health	5/10/2017	3/28/2022
Inactive	Combined Insurance Company of America	301472	Agent - Life	5/10/2017	3/28/2022
Inactive	New York Life Insurance Company	300431	Agent - Health	12/22/2020	3/28/2022
Inactive	New York Life Insurance Company	300431	Agent - Life	12/22/2020	3/28/2022
Active	Trustmark Insurance Company	300317	Agent - Health	10/9/2022
Active	Trustmark Insurance Company	300317	Agent - Life	10/9/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	L T C I Partners L L C	540090	Agent - Health
Denied	L T C I Partners L L C	540090	Agent - Life