Notification of Changes for Business Entity
General Information
Business Entity Name:	JOHN SNELLINGS INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	580970646
Ohio License Number:	38080
NPN:	5327068
DBA / Trade Name:
State of Domicile:	OH
County:	ATLANTA
Business Address
Address 1:	1117 PERIMETER CTR STE W101
Address 2:
City:	ATLANTA
State:	GA
Zip:	30338
Phone:	7703969600
Fax:	7703999880
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1117 PERIMETER CTR STE W101
Address 2:
City:	ATLANTA
State:	GA
Zip:	30338
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	SNELLINGS WALTERS INSURANCE AG
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:	CHRISTY KRICK
Title:	LICENSING ADMINISTRATOR
Phone Number:	8124942472
Email Address:	CKRICK@SUPPORTIVEIS.COM