Notification of Changes for Business Entity
General Information
Business Entity Name:	ABSOLUTE INTEGRITY INSURANCE
Incorporation / Formation Date:	09/01/2009
FEIN:	203537599
Ohio License Number:	40611
NPN:
DBA / Trade Name:
State of Domicile:	IN
County:	MARION
Business Address
Address 1:	432 S EMERSON AVE SUITE 130
Address 2:
City:	GREENWOOD
State:	IN
Zip:	46143
Phone:	3178831316
Fax:	3177438948
Business Web Site Address:	WWW.ABSOLUTEINTEGRITY.NET
Business Email Address:	JUSTINHONEY@ABSOLUTEINTEGRITY.NET
Mailing Address
Address 1:	432 S EMERSON AVE SUITE 130
Address 2:
City:	GREENWOOD
State:	IN
Zip:	46143
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)	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:	JUSTIN HONEY
Title:	PRESIDENT
Phone Number:	3178831316
Email Address:	JUSTINHONEY@ABSOLUTEINTEGRITY.NET