Notification of Changes for Business Entity
General Information
Business Entity Name:	PAYCHEX INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	16-1528391
Ohio License Number:	29630
NPN:	1914899
DBA / Trade Name:
State of Domicile:	NY
County:	MONROE
Business Address
Address 1:	150 SAWGRASS
Address 2:
City:	ROCHESTER
State:	NY
Zip:	14620
Phone:	5853367600
Fax:
Business Web Site Address:	WWW.PAYCHEX.COM
Business Email Address:
Mailing Address
Address 1:	150 SAWGRASS DRIVE
Address 2:
City:	ROCHESTER
State:	NY
Zip:	14620
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
EMILIO SCOCCIA	SALES REP	1147784	YES		05/26/2017
CHERYL LYNN CACCAMISE	SALES REP	1147676	YES		05/26/2017
PHILIP ANTHONY CACCAMISE	SALES REP	1147686	YES		05/26/2017
RICHARD ALAN CHAPMAN LL	SALES REP	1147657	YES		05/26/2017
KRISTINA JEAN CONLOGUE	SALES REP	1147693	YES		05/26/2017
JEFFREY P FINUCANE	SALES REP	1147692	YES		05/26/2017
SEAN PATRICK CONLON	SALES REP	1147761	YES		05/26/2017
MARIE M GOLLAHER	SALES REP	1147765	YES		05/26/2017
ALAN INGRASSIO	SALES REP	1147784	YES		05/26/2017
ROCKY LEUZZI	SALES REP	1147800	YES		05/26/2017
MICHAEL MATTHEW MATTEO	SALES REP	1147866	YES		05/26/2017
MICHAEL CHIEDU MONU	SALES REP	1147869	YES		05/26/2017
GEOFFREY DANIEL O CONNOR	SALES REP	1147872	YES		05/26/2017
DEANNA M SNOW	SALES REP	1147954	YES		05/26/2017
NICHOLAS M WEBER	SALES REP	1148030	YES		05/26/2017

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:	KRISTINE BLISS
Title:	COMPLIANCE SPECIALIST
Phone Number:	585-338-4159
Email Address:	KBLISS@PAYCHEX.COM