Notification of Changes for Business Entity
General Information
Business Entity Name:	MYLO, LLC
Incorporation / Formation Date:
FEIN:	822576713
Ohio License Number:	1171106
NPN:	18590034
DBA / Trade Name:
State of Domicile:	KS
County:	JOHNSON
Business Address
Address 1:	14425 COLLEGE BLVD STE 180
Address 2:
City:	LENEXA
State:	KS
Zip:	66215
Phone:	9139045300
Fax:
Business Web Site Address:
Business Email Address:	KCLICENSING@LOCKTON.COM
Mailing Address
Address 1:	14425 COLLEGE BLVD STE 180
Address 2:
City:	LENEXA
State:	KS
Zip:	66215
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
TYLER J ALLEE	AGENT	18619296	YES		04/11/2018
MILLIANNA R ANZEK	AGENT	18223180	YES		04/11/2018
HERMAN A FULLER BAPTISTE	AGENT	1028741	YES		04/11/2018
TYLER A BARRON	AGENT	18706931	YES		04/11/2018
EBONEE J BELL	AGENT	17833856	YES		04/11/2018
EDWARD J BENTON	AGENT	2065185	YES		04/11/2018
MACK E BREED	AGENT	18654370	YES		04/11/2018
KELLEY M BROWN	AGENT	18654561	YES		04/11/2018
MICHAEL C CLARK	AGENT	16363227	YES		04/11/2018
ALLEN R COLLINS	AGENT	18496942	YES		04/11/2018
KC J COLLINS	AGENT	14949267	YES		04/11/2018
NADIA A CRUTH	AGENT	15919122	YES		04/11/2018
ASHLEY S DALE	AGENT	18656879	YES		04/11/2018
MICHAEL J DOSENBACH	AGENT	18566959	YES		04/11/2018
ISHMAEL A ELKAMIL	AGENT	17525065	YES		04/11/2018

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:	JASON GIBSON
Title:	AUTHORIZED PERSON / MANAGER OF CALL CENTER
Phone Number:	9139045300
Email Address:	KCLICENSING@LOCKTON.COM