DEPARTMENT OF INSURANCE

Name	Black, Rose Marie	DOIID	521494	NAIC NPN	310413

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	2/9/2001	10/31/2008
Inactive	Non Resident	Agent	Health	2/9/2001	10/31/2008
Inactive	Non Resident	Agent	Casualty	2/9/2001	10/31/2008

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

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	K & K Insurance Group Inc 1712 Magnavox WayFort Wayne, IN 46804
Mailing	K & K Insurance Group Inc 1712 Magnavox WayFort Wayne, IN 46804
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(219) 459-5000 Ext-21945