DEPARTMENT OF INSURANCE

Name	Belliston, Dustin William	DOIID	712854	NAIC NPN	14677789

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	Life	9/3/2009	4/30/2011
Inactive	Non Resident	Agent	Health	9/3/2009	4/30/2011

*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	Extend Health Services 10975 Sterling View Dr Suite A1South Jordan, UT 84095
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(801) 413-0990