Notification of Changes for Business Entity
General Information
Business Entity Name:	THE WISEMAN AGENCY, INC.
Incorporation / Formation Date:	01/06/1976
FEIN:	310883269
Ohio License Number:	1189
NPN:	1702139
DBA / Trade Name:
State of Domicile:	OH
County:	GALLIA
Business Address
Address 1:	451 SECOND AVENUE
Address 2:
City:	GALLIPOLIS
State:	OH
Zip:	45631
Phone:	7404463643
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P. O. BOX 359
Address 2:
City:	GALLIPOLIS
State:	OH
Zip:	45631
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
CARA PLUMMER-PAXTON	AGENT	1005247		YES	3/5/2018
SHELLEY RENEE JAMES	AGENT	33732		YES	3/5/2018
SHIRLEEN WISEMAN	VICE PRESIDENT	300303111		YES	4/13/2018
RENEE HUNT	AGENT	1187468	YES		4/10/2018

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)	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:	LORI WAUGH
Title:	TREASURER
Phone Number:	7404463643
Email Address:	LWAUGH@WISEMANAGENCY.COM