Notification of Changes for Business Entity
General Information
Business Entity Name:	SEVEN CORNERS, INC.
Incorporation / Formation Date:	09/05/1997
FEIN:	352025404
Ohio License Number:	36603
NPN:	3320233
DBA / Trade Name:
State of Domicile:	IN
County:	HAMILTON
Business Address
Address 1:	303 CONGRESSIONAL BLVD
Address 2:
City:	CARMEL
State:	IN
Zip:	46032
Phone:	317-575-2652
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	303 CONGRESSIONAL BLVD
Address 2:
City:	CARMEL
State:	IN
Zip:	46032
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
RONALD FULTON	SALES SUPERVISOR	16499604	YES		02/08/2017

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:	DETRA REED
Title:	LICENSING COORDINATOR
Phone Number:	501-664-8044
Email Address:	DREED@CENTRALLICENSINGBUREAU.COM