Notification of Changes for Business Entity
General Information
Business Entity Name:	DEANS & HOMER
Incorporation / Formation Date:
FEIN:	941072984
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SAN FRANCISCO
Business Address
Address 1:	160 PINE ST
Address 2:	STE 510
City:	SAN FRANCISCO
State:	OH
Zip:	94111
Phone:	4154218332
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 2839
Address 2:
City:	SAN FRANCISCO
State:	OH
Zip:	94126
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	TYLER HOWARD
Title:	LICENSING MANAGER
Phone Number:	4154218332
Email Address:	LICENSING@DEANSHOMER.COM