DEPARTMENT OF INSURANCE

Name	Hazelbaker, Richard Keith	DOIID	384277	NAIC NPN	55108

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Prepaid Dental Plan	6/22/1998	1/24/2000
Pending Replacement	Resident	Agent	Health	1/22/1993		6/30/2024
Pending Replacement	Resident	Agent	Life	1/22/1993		6/30/2024

*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	04/15/2024	06/30/2024

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
Residence	Not Public Information
Business / Home Office	R Keith Hazelbaker Enterprises Inc 19011 Long Grove WayLouisville, KY 40245

Phone Information

Type	Phone
Business / Home Office	(502) 891-4478