DEPARTMENT OF INSURANCE

Name	Fortner, Terry Gene	DOIID	587713	NAIC NPN	8043019

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Life	4/22/2004	7/31/2024
Active	Resident	Agent	Health	4/21/2004	7/31/2024
Denied	Resident	Agent	Casualty
Denied	Resident	Agent	Property

*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	05/15/2024	07/31/2024

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	2511 Ft Campbell Blvd Hopkinsville, KY 42240

Internet Information

Type	Address
Business Email	terryfortner@outlook.com

Phone Information

Type	Phone
Business / Home Office	(270) 821-6931