Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
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
GONZELLA MCCOY	PRODUCER	17856601	YES		05/16/2016
HARRY STEINMAN	PRODUCER	5690887	YES		05/16/2016
HASLINA HART	PRODUCER	16204012	YES		05/16/2016
HEATHER COSTELLO	PRODUCER	17558176	YES		05/16/2016
HEATHER LABOUNTY	PRODUCER	17686284	YES		05/16/2016
HEATHER LOVE	PRODUCER	17345574	YES		05/16/2016
HECTOR FERNANDEZ	PRODUCER	17146139	YES		05/16/2016
HELEN HEAVENER	PRODUCER	17202778	YES		05/16/2016
IRIS NELSON	PRODUCER	6837663	YES		05/16/2016
IVAN RUIZ	PRODUCER	16910169	YES		05/16/2016
JACQUELINE NELSON	PRODUCER	70523641	YES		05/16/2016
JAMAAL KELLY	PRODUCER	16611833	YES		05/16/2016
JAMES DALY	PRODUCER	9135067	YES		05/16/2016
JAMES FARRIS	PRODUCER	6641382	YES		05/16/2016
JANA CAMPBELL	PRODUCER	16899648	YES		05/16/2016

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM