Notification of Changes for Business Entity
General Information
Business Entity Name:	TITLE ONE AGENCY, INC.
Incorporation / Formation Date:
FEIN:	34-1497567
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	STARK
Business Address
Address 1:	4618 DRESSLER ROAD NW
Address 2:
City:	CANTON
State:	OH
Zip:	44718
Phone:	3304937873
Fax:
Business Web Site Address:	WWW.TITLEONEOHIO.COM
Business Email Address:	MRILEY@TITLEONEOHIO.COM
Mailing Address
Address 1:	4618 DRESSLER ROAD NW
Address 2:
City:	CANTON
State:	OH
Zip:	44718
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
MICAH EVERETT RILEY	PRESIDENT	8488815	YES		4/27/16
DIANE JACKSON	MANAGER	4802949		YES	4/27/16
DELRICA MARTIN-GRUBBS	ESCROW OFFICER	8826013		YES	4/27/16
SHANE DRYDEN	ESCROW OFFICER	7921969	YES		4/27/16
CONSTANCE GONZALEZ	ESCROW ASSISTANT	17829322	YES		4/27/16

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MICAH EVERETT RILEY -46% OWNER	PRESIDENT/CO-OWNER	8488815	YES		4/27/16
JAY L. CUTLER - 24.75% OWNER	FOUNDER/CO-OWNER
JAMES H. CAMP - 20% OWNER	CO-OWNER
JAMES ANDREW CAMP -4.75% OWNER	CO-OWNER		YES		4/27/16
SUSAN P. BRAY - 4.5% OWNER	CO-OWNER
CYNTHIA S. CAMP	FORMER CO-OWNER			YES	4/27/16
JAMES BRAY	FORMER CO-OWNER			YES	4/27/16
PENNEY CUTLER	FORMER CO-OWNER			YES	4/27/16
*SOME NAMES ABOVE SHOWN FOR	% OWNERSHIP CHANGE ONLY			YES

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	YES
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	JAY CUTLER, JAMES H. CAMP, JAMES ANDREW CAMP ARE CO-OWNERS IN A REAL ESTATE BROKERAGE (CUTLER REAL ESTATE).

Submitted By
Submitted By:	MICAH E. RILEY
Title:	PRESIDENT
Phone Number:	3303385130
Email Address:	MRILEY@TITLEONEOHIO.COM