DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Kirby, Justin Carlisle	DOIID	780635	NAIC NPN	10523504

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Preneed Funeral	3/6/2024		4/30/2026
Inactive	Non Resident	Agent	Life	5/1/2012	4/30/2014
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Kentucky Funeral Directors Life Insurance Company	532905	Agent - Preneed Funeral	3/18/2024
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	5/25/2012	4/30/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Todd County Funeral Home	714859	Agent - Life	5/25/2012	3/31/2014