Notification of Changes for Business Entity
General Information
Business Entity Name:	HOLMES MURPHY AND ASSOCIATES, LLC
Incorporation / Formation Date:
FEIN:	42-0985055
Ohio License Number:	25026
NPN:	765524
DBA / Trade Name:
State of Domicile:	IN
County:	DALLAS
Business Address
Address 1:	2727 GRAND PRAIRIE PKWY
Address 2:
City:	WAUKEE
State:	IA
Zip:	50263
Phone:	515-223-6800
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2727 GRAND PRAIRIE PKWY
Address 2:
City:	WAUKEE
State:	IA
Zip:	50263
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
JORGE GABRIEL PEREZ LAHAM	BENEFITS COORD	1179938	YES		3/15/2018

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:	STEPHANIE MULSTAY
Title:	COMPLIANCE ADMINISTRATOR
Phone Number:	515-974-5974
Email Address:	SMULSTAY@HOLMESMURPHY.COM