DEPARTMENT OF INSURANCE

Name	Carbone, Tal Adam	DOIID	628241	NAIC NPN	1911268

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Property	3/20/2006	7/31/2009
Inactive	Non Resident	Agent	Casualty	3/20/2006	7/31/2009

*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
Residence	Not Public Information
Business / Home Office	965 Ne 22nd St Gresham, OR 97030

Internet Information

Type	Address
Business Email	poundj@nationwide.com - Bad Email-Correction requested

Phone Information

Type	Phone
Business / Home Office	(503) 238-4111