Notification of Changes for Business Entity
General Information
Business Entity Name:	ALLIANCE-ONE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	74-2764079
Ohio License Number:	12941
NPN:	2014644
DBA / Trade Name:	N/A
State of Domicile:	ND
County:	BURLEIGH
Business Address
Address 1:	99 BUCKSHIRE PLACE
Address 2:
City:	HOLLAND
State:	PA
Zip:	18966
Phone:	215-582-0086
Fax:	469-499-2658
Business Web Site Address:
Business Email Address:	DCIERI@CSC.COM
Mailing Address
Address 1:	99 BUCKSHIRE PLACE
Address 2:
City:	HOLLAND
State:	PA
Zip:	18966
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:	MICHELLE MCALLISTER SMITH
Title:	COMPLIANCE OFFICER
Phone Number:	512-565-9655
Email Address:	MMCALLISTER@CSC.COM