Notification of Changes for Business Entity
General Information
Business Entity Name:	STAMMEN INSURANCE GROUP LLC
Incorporation / Formation Date:	05/01/2017
FEIN:	82-1247255
Ohio License Number:	1147863
NPN:	18411643
DBA / Trade Name:
State of Domicile:	OH
County:	MERCER
Business Address
Address 1:	115-117 S. MAIN STREET
Address 2:	PO BOX 268
City:	CELINA
State:	OH
Zip:	45822
Phone:	419-586-7500
Fax:	419-586-1965
Business Web Site Address:
Business Email Address:	WWW.CORPORATE@STAMMENINSURANCE.COM
Mailing Address
Address 1:	P.O. BOX 268
Address 2:
City:	CELINA
State:	OH
Zip:	45822
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
CHARLES J STAMMEN	PRODUCER	566525	YES		05/01/2017
WILLIAM J STAMMEN	PRODUCER	2827104	YES		05/01/2017
MARK J STAMMEN	PRODUCER	2772460	YES		05/01/2017
SHARON M WELLMAN	AGENT	2772284	YES		05/01/2017
JOYCE WINNER	AGENT	2341491	YES		05/01/2017
JANICE A HARTKE	AGENT	7404971	YES		05/01/2017
FONDA MASON	AGENT	2206564	YES		05/01/2017
KRISTINE M HISER	AGENT	3935447	YES		05/01/2017
DEBORAH A BLAKE	AGENT	3417461	YES		05/01/2017
DORIS M BRUGGEMAN	AGENT	2772674	YES		05/01/2017
CONSTANCE M GRILLIOT	AGENT	2441193	YES		05/01/2017
PATRICIA L SELHORST	AGENT	2772459	YES		05/01/2017
LYNDA GRIESDORN	AGENT	2772522			05/01/2017
AMY M SHEAKS	AGENT	15838390	YES		05/01/2017
TARA FULLENKAMP	AGENT	17760250	YES		05/01/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DAVE STAMMEN	AGENT	2448834	YES		05/01/2017
LORI HUBBLE	AGENT	1776023	YES		05/01/2017
ROBERT J HOWELL	OWNER	18391373	YES		05/01/2017

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)	NO
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?	NO
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:	CONNIE M. GRILLIOT
Title:	OFFICE MANAGER
Phone Number:	419-586-7500
Email Address:	CGRILLIOT@STAMMENINSURANCE.COM