DEPARTMENT OF INSURANCE

Name	Custenborder, Patrick Raymond	DOIID	356268	NAIC NPN	1488988

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	9/5/1995		3/31/2025
Active	Non Resident	Agent	Health	9/5/1995		3/31/2025
Inactive	Non Resident	Agent	Health Maintenance Organization	12/30/1998	3/1/2001

*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	01/15/2025	03/31/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	Phelan Insurance Agency Inc P.O. Box 1 863 East Main StreetVersailles, OH 45380
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(937) 526-3111