Notification of Changes for Business Entity
General Information
Business Entity Name:	HOMESTEAD INSURANCE AENCY INC
Incorporation / Formation Date:	01/02/1982
FEIN:	34-1354043
Ohio License Number:	988
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	MEDINA
Business Address
Address 1:	1324 PEARL ROAD
Address 2:
City:	BRUNSWICK
State:	OH
Zip:	44212
Phone:	330-225-3100
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 0802
Address 2:
City:	BRUNSWICK
State:	OH
Zip:	44212
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
CONSTANCE MARIE MCGUIRE	LIFE/HEALTH AGT	8201064	YES		10/05/2016

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:	VALERIE L RAPP
Title:	SEC/TREA
Phone Number:	330-225-3100
Email Address:	V.RAPP@HOMESTEADINS.COM