Notification of Changes for Business Entity
General Information
Business Entity Name:	COURTHOUSE PLAZA TITLE AGENCY, LLC
Incorporation / Formation Date:
FEIN:	31-0263070
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	MONTGOMERY
Business Address
Address 1:	ONE SOUTH MAIN STREET, SUITE 1300
Address 2:
City:	DAYTON
State:	OH
Zip:	45402
Phone:	(937) 449-6400
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	ONE SOUTH MAIN STREET, SUITE 1300
Address 2:
City:	DAYTON
State:	OH
Zip:	45402
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
KEVIN V. SIMON	PRODUCER	18408052	YES		1/1/18
ALEXANDER A. ARESTIDES	RDA	3239075		YES	1/1/18

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)	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	PRODUCER IS AN ATTORNEY

Submitted By
Submitted By:	FREDERICK J. CASPAR
Title:	DIRECTOR
Phone Number:	9374496400
Email Address:	FRED.CASPAR@DINSMORE.COM