Notification of Changes for Business Entity
General Information
Business Entity Name:	CUMBRLAND SURETY, INC.
Incorporation / Formation Date:
FEIN:	90-0956028
Ohio License Number:	27759
NPN:	16939681
DBA / Trade Name:
State of Domicile:	KY
County:	FAYETTE
Business Address
Address 1:	340 S BROADWAY
Address 2:	SUITE 100
City:	LEXINGTON
State:	KY
Zip:	40508
Phone:	859 254 8622
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	340 S BROADWAY
Address 2:	SUITE 100
City:	LEXINGTON
State:	KY
Zip:	40508
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
DEBORAH MURPHY	PRODUCER -RDA	7136116	YES		5/10/18
WILLIAM ADAMS	RDA	2870232		YES	5/10/18

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
WILLIAM H.M. PATTERSON	PRESIDENT	7136117	YES		5/10/18
WILLIAM ADAMS	PRESIDENT	2870232		YES	5/10/18

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:	DON P CHARLET
Title:	VICE PRESIDENT
Phone Number:	859 254 8622
Email Address:	DCHARLET@CUMBERLANDSURETY.COM