Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES, INC
Incorporation / Formation Date:
FEIN:	47-0791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103 RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103 RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
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
COFFEY, ANGELA	AGENT	1094975		YES	06/29/16
COX, ASHLEY	AGENT	1102186		YES	06/29/16
DANIEL, DYLAN	AGENT	1099555		YES	06/29/16
HAMMOND, JR., RICHARD	AGENT	1099521		YES	06/29/16
SHELBY, HARRIS	AGENT	1106648		YES	06/29/16
HATCH, WILLIAM	AGENT	1087709		YES	06/29/16
HILL, BRIAN	AGENT	1067537		YES	06/29/16
MCBATH, SERENA	AGENT	966870		YES	06/29/16
MCMILLEN, MICHAEL	AGENT	1070671		YES	06/29/16
MOUNTS, II, PATRICK	AGENT	1037898		YES	06/29/16
NANCE, CHARLES	AGENT	1065657		YES	06/29/16
ROTHENBERGER, MARK	AGENT	1101818		YES	06/29/16
ROYSTER, LAKEISHA	AGENT	1058940		YES	06/29/16
TREECE, TANNER	AGENT	1101819		YES	06/29/16
UPTON, JONATHAN	AGENT	1099540		YES	06/29/16

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:	MARLA HUGHES
Title:	AGENT
Phone Number:	402-963-2361
Email Address:	AGENT@SITEL.COM