black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

LAKE GROWTH

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN301404
Status:
First Licensure:
01/19/2018
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
303 N 2ND ST STE 23A
ST CHARLES, IL 60174-1804
Mailing:
303 N 2ND ST STE 23A
ST CHARLES, IL 60174-1804
Phone:
+1 (312) 724-7362
Fax:
+1 (312) 724-8583
Email:
markwillis@lakegrowth.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 07/15/2021 04/01/2027
*** NOT ACTIVE *** 07/01/2021 07/14/2021
NON-RESIDENT PRODUCER AGENCY 01/19/2018 06/30/2021

Alias, DBA or Trade Name

Name
LAKE GROWTH FINANCIAL SERVICES

Employer

Name Issue Date License Number Expiration Date Cancel Date
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA
10/03/2022 LHF846
LAFAYETTE LIFE INSURANCE COMPANY
01/22/2018 LHF202 07/01/2021
LAFAYETTE LIFE INSURANCE COMPANY
08/23/2021 LHF202
SECURITY MUTUAL LIFE INSURANCE COMPANY OF NEW YORK
03/18/2024 LHF262

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
MARK WILLIS
07/15/2021 PRN301139

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
MARK WILLIS PRN301139

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
16871060

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 05/14/2025 10:30:44 PM