Notification of Changes for Business Entity
General Information
Business Entity Name:	HILL & HAMILTON INC.
Incorporation / Formation Date:
FEIN:	341339727
Ohio License Number:	4442
NPN:	1881475
DBA / Trade Name:
State of Domicile:	OH
County:	LOGAN
Business Address
Address 1:	PO BOX 160
Address 2:	200 DOWELL AVE.
City:	BELLEFONTAINE
State:	OH
Zip:	43311
Phone:	9375929076
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 160
Address 2:
City:	BELLEFONTAINE
State:	OH
Zip:	43311
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
LEAH LOEHR	ACCOUNT MANAGER	17858671	YES		5/2/2016

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:	THOMAS J SIMON
Title:	PRESIDENT
Phone Number:	9375929076
Email Address:	MSIMON@HILLANDHAMILTON.COM