Notification of Changes for Business Entity
General Information
Business Entity Name:	WASHINGTON MUTUAL INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	34-1813283
Ohio License Number:	4920
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	WAYNE
Business Address
Address 1:	3873 CLEVELAND RD
Address 2:
City:	WOOSTER
State:	OH
Zip:	44691
Phone:	330-345-8100
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3873 CLEVELAND RD
Address 2:
City:	WOOSTER
State:	OH
Zip:	44691
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
KATHLEEN CICCONETTI	AGENT	302-48-5421		YES	8/2/2011
NATALIE CULLER	AGENT	1834288	YES		2/26/2016
AMY HANES	AGENT	1812573	YES		2/18/2016
JILL SPONSELLER	AGENT	16759867	YES		8/30/2012
JONATHON SUTTLE	AGENT	13603523	YES		6/22/2012
SUSAN SWARTZ	AGENT	3239777	YES		10/3/2013
MARIE WILKER	AGENT	3241161	YES		10/3/2013

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JAMES T RHAMEY	PRESIDENT	270-40-2951		YES	7/1/2009
JAMES T RHAMEY	STOCKHOLDER	270-40-2951		YES	7/1/2009
DAVID TSCHANTZ	PRESIDENT	279-46-5169	YES		7/31/2009
NORMAN LEWIS	VICE PRESIDENT	297-58-7804	YES		7/31/2009
TIMOTHY SUPPES	SECRETARY	291-44-4562	YES		7/31/2009

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:	KOURTNEY YODER
Title:	MARKETING SUPERVISOR
Phone Number:	330-345-8100
Email Address:	KOURTNEY_YODER@WAYNEINSGROUP.COM