Notification of Changes for Business Entity
General Information
Business Entity Name:	TITLE SOURCE, INC.
Incorporation / Formation Date:	05/01/1997
FEIN:	38-3355344
Ohio License Number:	27922
NPN:	1009282
DBA / Trade Name:
State of Domicile:	MI
County:	WAYNE
Business Address
Address 1:	662 WOODWARD AVE.
Address 2:
City:	DETROIT
State:	MI
Zip:	48226
Phone:	8888485355
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	662 WOODWARD AVE.
Address 2:
City:	DETROIT
State:	MI
Zip:	48226
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
MARK S. COOK	ACCOUNT EXECUTIVE	609822		YES	09/19/2016

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:	JEFFREY EISENSHTADT
Title:	PRESIDENT/CEO
Phone Number:	3138772222
Email Address:	JEFF@TITLESOURCE.COM