Notification of Changes for Business Entity
General Information
Business Entity Name:	GERMAN AMERICAN INS., INC.
Incorporation / Formation Date:
FEIN:	351985025
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	IN
County:	DUBOIS
Business Address
Address 1:	246 THIRD AVE.
Address 2:
City:	JASPER
State:	IN
Zip:	47546
Phone:	812-482-2866
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	246 THIRD AVE.
Address 2:
City:	JASPER
State:	IN
Zip:	47546
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JOE A. DEDMAN	PRES.	307607557		YES	5-1-18
ZACHARY A. SIBREL	PRES./CEO	314826215	YES		5-1-18

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:	ZACHARY A. SIBREL
Title:	PRES./CEO
Phone Number:	812-482-2866
Email Address:	ZACH.SIBREL@GERMANAMERICAN.COM