Notification of Changes for Business Entity
General Information
Business Entity Name:	INVEST FINANCIAL CORPORATION INSURANCE AGENCY INC OF IL
Incorporation / Formation Date:
FEIN:	363325488
Ohio License Number:	35557
NPN:
DBA / Trade Name:
State of Domicile:	FL
County:	HILLSBOROUGH
Business Address
Address 1:	12750 CITRUS PARK LN STE 300
Address 2:
City:	TAMPA
State:	FL
Zip:	33625
Phone:	8002424732
Fax:	8138906408
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	12720 CITRUS PARK LN STE 300
Address 2:
City:	TAMPA
State:	FL
Zip:	33625
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
DANIEL FELLERS	AGENT	2828825	YES		9/20/2017
MICHELLE BENDER	AGENT	6836387	YES		9/20/2017
RONALD ROSSELOT	AGENT	2425243		YES	9/15/2017

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:	LORI LAPOLE
Title:	LICENSING DEPT
Phone Number:	8002424732
Email Address:	REGISTRATION@INVESTFINANCIAL.COM