DEPARTMENT OF INSURANCE

Name	Mayberry Jr, Charles E	DOIID	391014	NAIC NPN	829466

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/25/1994		2/28/2025
Active	Non Resident	Agent	Life	10/25/1994		2/28/2025
Inactive	Non Resident	Agent	Health Maintenance Organization	6/9/1995	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	12/15/2024	02/28/2025

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	2019 Andres Way Floyds Knobs, IN 471194500
Residence	Not Public Information

Internet Information

Type	Address
Business Email	cmayberry812@gmail.com

Phone Information

Type	Phone
Business / Home Office	(812) 406-3330