Notification of Changes for Business Entity
General Information  
Business Entity Name: FARMERS MUTUAL INSURANCE AGENCY, INC
Incorporation / Formation Date:  
FEIN: 341637232
Ohio License Number: 825
NPN: 2213141
DBA / Trade Name:  
State of Domicile: OH
County: WYANDOT
Business Address  
Address 1: 150 HIGHLAND PARKWAY
Address 2: PO BOX 239
City: UPPER SANDUSKY
State: OH
Zip: 43351
Phone: 4192942862
Fax: 4192945263
Business Web Site Address: WWW.FARMERSMUTUALAGENCY.COM
Business Email Address:  
Mailing Address  
Address 1: 150 HIGHLAND PARKWAY
Address 2: PO BOX 239
City: UPPER SANDUSKY
State: OH
Zip: 43351
   
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
DANNY L OAKES RDA 313588773   YES 01/09/2018
DANNY L OAKES SECRETARY 313588773   YES 01/09/2018
JOHN D WHEELER AGENT 284421318   YES 01/09/2018
KENNETH M HEIMLICH AGENT 1111111111   YES 01/09/2018
MARLENE MCCLEARY AGENT 292565367   YES 01/09/2018
LARRY ROLL DIRECTOR 2222222222   YES 01/09/2018
NATHAN WEAVER AGENT 298884794   YES 01/09/2018
DAVID M BEAZLEY AGENT 300468284   YES 01/09/2018
JENNIFER GEISEY EMPLOYEE 286821387   YES 01/09/2018
NICOLE BISCHOFF AGENT 1074275 YES   01/09/2018
JAMES ROBINSON II CSR 287866139 YES   01/09/2018
           
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) 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: SHERRY L. WARD
Title: AGENCY MANANGER
Phone Number: 419-294-2862
Email Address: SWARD@FARMERS-MUTUAL.COM