DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Lance N	DOIID	1044044	NAIC NPN	9674893

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	6/14/2019	12/31/2022
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Lifetime Benefit Solutions, Inc.	574373	Agent - Health