Notification of Changes for Business Entity
General Information
Business Entity Name:	LOCAL CHOICE INSURANCE LLC
Incorporation / Formation Date:
FEIN:	815236960
Ohio License Number:	1143195
NPN:	18312508
DBA / Trade Name:
State of Domicile:	KY
County:	USA
Business Address
Address 1:	12305 WESTPORT ROAD STE 103
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40245
Phone:	5029072399
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	12305 WESTPORT ROAD STE 103
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40245
Indicate the type of change you are seeking
Address Change:	YES
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
VICTOR LANGENDEFER	ACCOUNT MANAGER	18397857	YES		08/25/2017
ERICA REITER	OFFICE MANAGER	306083732	YES		08/25/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
WILLIAM SCHUMANN	OWNER	7216281	YES		08/25/2017

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:	WILLIAM SCHUMANN
Title:	OWNER
Phone Number:	5029072399
Email Address:	BILL@LOCALCHOICEINSURANCE.COM