DEPARTMENT OF INSURANCE

Name	Dombrosky, David Alan	DOIID	375109	NAIC NPN	765795

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	8/15/2000	1/31/2006
Inactive	Non Resident	Agent	Health	1/12/2003	1/31/2006
Inactive	Non Resident	Agent	Variable Life and Variable Annuities	1/13/2003	1/31/2006
Inactive	Non Resident	Agent	General Lines	12/10/1998	8/15/2000
Inactive	Non Resident	Agent	Casualty	8/15/2000	1/31/2006
Inactive	Non Resident	Agent	Life	1/13/2003	1/31/2006

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

No License Renewal Information

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	CitiStreet Associates 2550 Northwinds Parkway Suite 550Alpharetta, GA 30004
Mailing	909 Cypress Way Sevierville, TN 37876
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(704) 544-8383