Notification of Changes for Business Entity
General Information
Business Entity Name:	STRATTON AGENCY
Incorporation / Formation Date:
FEIN:	900762996
Ohio License Number:	955426
NPN:	16442498
DBA / Trade Name:
State of Domicile:	CA
County:	SAN MATEO
Business Address
Address 1:	643 BAIR ISLAND ROAD
Address 2:	SUITE 402
City:	REDWOOD CITY
State:	CA
Zip:	94063
Phone:	888-888-4501
Fax:	650-508-0121
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	463 BAIR ISLAND ROAD
Address 2:	SUITE 402
City:	REDWOOD CITY
State:	CA
Zip:	94063
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	RYAN HEADLEY
Title:	COO/PARTNER
Phone Number:	650-508-0116
Email Address:	RYAN@STRATTONAGENCY.COM