Notification of Changes for Business Entity
General Information
Business Entity Name:	OFFENBERG AND ASSOCIATES INSURANCE AGENCY, INC.
Incorporation / Formation Date:
FEIN:	31-0926435
Ohio License Number:	2146
NPN:	957487
DBA / Trade Name:
State of Domicile:	OH
County:	OHIO
Business Address
Address 1:	33 NORTH REMINGTON ROAD
Address 2:
City:	BEXLEY
State:	OH
Zip:	43209
Phone:	6142368891
Fax:
Business Web Site Address:
Business Email Address:	JOFFENB503@AOL.COM
Mailing Address
Address 1:	33 NORTH REMINGTON ROAD
Address 2:
City:	BEXLEY
State:	OH
Zip:	43209
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	OFFENBERG AND ASSOCIATES INSUR
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
JOHN H OFFENBERG OFFENBERG	PRESIDENT	247289	YES		1972

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JOHN H OFFENBERG OFFENBERG	PRESIDENT	247289			1972

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:	JOHN H. OFFENBERG
Title:	PRESIDENT
Phone Number:	6142368891
Email Address:	JOFFENB503@AOL.COM