DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Combined Insurance Company of America	301472	Agent - Health	8/19/2024
Active	Combined Insurance Company of America	301472	Agent - Life	8/19/2024
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