DEPARTMENT OF INSURANCE

Name	Burgess, Lori Dawn	DOIID	665622	NAIC NPN	9726179

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Resident	Agent	Limited Line Credit	6/13/2017	9/30/2018

*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	Jackson Purchase Aca 308 S. Washington St. Po Box 220Clinton, KY 42031
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(270) 653-4307