Notification of Changes for Business Entity
General Information
Business Entity Name:	THE LONG AGENCIES INC
Incorporation / Formation Date:
FEIN:	710846087
Ohio License Number:
NPN:	8155059
DBA / Trade Name:
State of Domicile:	AR
County:	WASHINGTON
Business Address
Address 1:	2901 E ZION RD STE 1
Address 2:
City:	FAYETTEVILLE
State:	AR
Zip:	72703
Phone:	479-444-7224
Fax:
Business Web Site Address:
Business Email Address:	JEROMIE@GENELONGAGENCY.COM
Mailing Address
Address 1:	2901 E ZION RD STE 1
Address 2:
City:	FAYETTEVILLE
State:	AR
Zip:	72703
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
BRAD BARNETT	AGENT	1199734	YES		07/19/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
BRAD BARNETT	AGENT	1199734	YES		07/19/2018

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:	GENE LONG
Title:	OWNER
Phone Number:	4794447224
Email Address:	JEROMIE@GENELONGAGENCY.COM