Notification of Changes for Business Entity
General Information
Business Entity Name:	UNIVERSAL 1 CREDIT UNION
Incorporation / Formation Date:
FEIN:	31-0387145
Ohio License Number:	34264
NPN:	8733873
DBA / Trade Name:
State of Domicile:	OH
County:	MONTGOMERY
Business Address
Address 1:	1 RIVER PARK DR
Address 2:
City:	DAYTON
State:	OH
Zip:	45409
Phone:	937-225-9290
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1 RIVER PARK DR
Address 2:
City:	DAYTON
State:	OH
Zip:	45409
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
HALEY DAWN SMITH	CUEM	1207492		YES	9/28/2018

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)	YES
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?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	SHE WORKED FOR UNIVERSAL 1 CREDIT UNION

Submitted By
Submitted By:	LESA GARWOOD
Title:	RDA
Phone Number:	937-225-9290
Email Address:	LGARWOOD@U1CU.ORG