Notification of Changes for Business Entity
General Information
Business Entity Name:	PROSPERITY MARKETING GROUP
Incorporation / Formation Date:	01/02/2009
FEIN:	26-4018139
Ohio License Number:	39820
NPN:	12881360
DBA / Trade Name:
State of Domicile:	NC
County:	WAKE
Business Address
Address 1:	5565 CENTERVIEW DR
Address 2:	SUITE 200
City:	RALEIGH
State:	NC
Zip:	27606
Phone:	919-851-0846
Fax:
Business Web Site Address:
Business Email Address:	JACKIE.CLIFFORD@7APA.COM
Mailing Address
Address 1:	5565 CENTERVIEW DR
Address 2:	SUITE 200
City:	RALEIGH
State:	NC
Zip:	27606
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
LEIGH SMITH	PRESIDENT	18430836	YES		12/1/17
THOMAS MCDERMOTT	PRESIDENT	2360031		YES	12/1/17

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:	JACKIE CLIFFORD
Title:	ACCOUNTING MANAGER
Phone Number:	919-2567205
Email Address:	JACKIE.CLIFFORD@7APA.COM