Notification of Changes for Business Entity
General Information
Business Entity Name:	WINDERL KAMINSKY INSURANCE
Incorporation / Formation Date:
FEIN:	31-1481830
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	FAIRFIELD
Business Address
Address 1:	1424 ETY RD NW
Address 2:
City:	LANCASTER
State:	OH
Zip:	43130
Phone:	7406547782
Fax:
Business Web Site Address:	WINDERL KAMINSKY INSURANCE
Business Email Address:	JOAN@WKOHIO.COM
Mailing Address
Address 1:	1424 ETY RD NW
Address 2:
City:	LANCASTER
State:	OH
Zip:	43130
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
ALISHA PAUL	PRODUCER	18909180		YES	11/02/2018
LISA K SMITH	PRODUCER	18774818	YES		11/08/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JOAN C KAMINSKY

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:	JOAN KAMINSKY
Title:	PRINCIPAL/AGENT
Phone Number:	17406547782
Email Address:	JOAN@WKOHIO.COM