DEPARTMENT OF INSURANCE

Name	Sams, Shannon Dell	DOIID	304965	NAIC NPN	7157860

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Life	6/16/1992		6/30/2027
Active	Resident	Agent	Health	6/16/1992		6/30/2027
Active	Resident	Agent	Casualty	7/30/2003		6/30/2027
Active	Resident	Agent	Property	7/30/2003		6/30/2027
Inactive	Resident	Agent	General Lines	12/12/1989	8/15/2000

*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	04/15/2025	06/30/2025	02/10/2025	02/10/2025	Yes

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	Dell Sams Insurance 109 N. Commonwealth P.O. Box 1290Corbin, KY 40702
Mailing	Dell Sams Insurance 109 N. Commonwealth P.O. Box 1290Corbin, KY 40702
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(606) 528-8120