Notification of Changes for Business Entity
General Information
Business Entity Name:	LEGAL STRUCTURES, INC.
Incorporation / Formation Date:
FEIN:	341924752
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	GEAUGA
Business Address
Address 1:	17108 CATSDEN RD. SUITE 100
Address 2:
City:	CHAGRIN FALLS
State:	OH
Zip:	44023
Phone:	4405433799
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P.O. BOX 776
Address 2:
City:	CHAGRIN FALLS
State:	OH
Zip:	44022
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
CYNTHIA MILLER	AGENT	4670212	YES		10-1-2017
REGINALD MILLER	AGENT	256922	YES		10-1-2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
CYNTHIA MILLER

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)	NO
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?	NO
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:	KIMBERLY L. STEGER
Title:	PRESIDENT
Phone Number:	4405433799
Email Address:	RICK@LEGALSTRUCTURES.COM