Notification of Changes for Business Entity
General Information
Business Entity Name:	FARMERS NATIONAL COMPANY
Incorporation / Formation Date:
FEIN:	470157270
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NE
County:	DOUGLAS
Business Address
Address 1:	11516 NICHOLAS ST, STE 100
Address 2:
City:	OMAHA
State:	NE
Zip:	68154
Phone:	402 496 3276
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	BOX 542016
Address 2:
City:	OMAHA
State:	NE
Zip:	68154
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
MICHELE ANDERSEN	ASSISTANT VP	3185932	YES		5/3/2016

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)	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:	MICHELE ANDERSEN
Title:	ASSISTANT VP
Phone Number:	402 496 3276
Email Address:	MANDERSEN@FARMERSNATIONAL.COM