Notification of Changes for Business Entity
General Information
Business Entity Name:	GREGORY-SHAW FINANCIAL SERVICES INC
Incorporation / Formation Date:
FEIN:	30-0005544
Ohio License Number:	1089460
NPN:	1450764
DBA / Trade Name:
State of Domicile:	IN
County:	INDIANA
Business Address
Address 1:	480 LN 890 SNOW LAKE
Address 2:
City:	FREMONT
State:	IN
Zip:	46737
Phone:	260-432-4068
Fax:	720-228-6333
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	921 EAST DUPONT ROAD STE 249
Address 2:
City:	FORT WAYNE
State:	IN
Zip:	46825
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
CAROLYN J CODER

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:	CAROLYN J. CODER
Title:	SECRETARY-TREASURER AND AGENT
Phone Number:	260-432-4068
Email Address:	CAROLYN@GSFSERVICES.COM