DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Street, Hiawatha Ray	DOIID	932560	NAIC NPN	17219534

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/10/2016		2/28/2025
Active	Non Resident	Agent	Life	10/10/2016		2/28/2025
* 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
Active	Freedom Life Insurance Company of America	300074	Agent - Health	10/13/2016
Active	Freedom Life Insurance Company of America	300074	Agent - Life	10/13/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Ushealth Advisors Llc	713288	Agent - Life	10/14/2016
Active	Ushealth Advisors Llc	713288	Agent - Health	10/14/2016