Notification of Changes for Business Entity
General Information
Business Entity Name:	INSURANCE SERVICE OF ASHEVILLE
Incorporation / Formation Date:	06/01/1958
FEIN:	560668722
Ohio License Number:
NPN:	6618724
DBA / Trade Name:
State of Domicile:	NC
County:	BUNCOMBE
Business Address
Address 1:	408 EXECUTIVE PARK
Address 2:
City:	ASHEVILLE
State:	NC
Zip:	28801
Phone:	828-253-1668
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 530
Address 2:
City:	ASHEVILLE
State:	NC
Zip:	28802
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
JAMES STICKNEY	PRESIDENT	641739	YES		07/18/2012

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

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)
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?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	MARYALICE BELL
Title:	VP OF FINANCE
Phone Number:	828-253-1668
Email Address:	MBELL@ISA-AVL.COM