Notification of Changes for Business Entity
General Information
Business Entity Name:	CENTRAL OHIO INSURANCE ADVISORS
Incorporation / Formation Date:	09/07/2017
FEIN:	82-1963252
Ohio License Number:	1069025
NPN:	18531545
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	7311 SKYLINE DR E
Address 2:
City:	COLUMBUS
State:	OH
Zip:	43235
Phone:	6142146159
Fax:	6149448543
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7311 SKYLINE DR E
Address 2:
City:	COLUMBUS
State:	OH
Zip:	43235
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
WESTON SHEFFEL	OWNER	17582413	YES		10/01/2017
ROBERT KIM	OWNER	9472103		YES	10/01/2017

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	N/A

Submitted By
Submitted By:	ROBERT KIM
Title:	OWNER
Phone Number:	614-937-8827
Email Address:	BERTOKIM40@GMAIL.COM