Notification of Changes for Business Entity
General Information
Business Entity Name:	FIFTH THIRD INSURANCE AGENCY
Incorporation / Formation Date:
FEIN:	311282942
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	HAMILTON
Business Address
Address 1:	34 FOUNTAIN SQUARE PLAZA
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45263
Phone:	5135347421
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	34 FOUNTAIN SQUARE PLAZA
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45263
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
S. CHARLES FARIS	INVESTMENT EXECUTIVE	2205054		YES	12/09/2015
CONOR FLANAGAN	WEALTH MANAGEMENT ADVISOR	7021363		YES	12/09/2015
DAVID JUDY	WEALTH MANAGEMENT ADVISOR	2266886		YES	12/09/2015
CALEB FRANKART	INVESTEMENT REPRESENTATIVE	16844668		YES	12/09/2015
STEPHEN ALBRITTON	INVESTMENT EXECUTIVE	6586511		YES	12/09/2015
ELLIOTT CLARK	INVESTMENT REPRESENTATIVE	17115303		YES	12/09/2015
REBECCA ARNOLD	INVESTMENT REPRESENTATIVE	2258886		YES	12/09/2015
ANTHONY MAYER	INVESTMENT REPRESENTATIVE	8460150		YES	12/09/2015
KELLY TAMBLYN	INVESTMENT REPRESENTATIVE	16970435		YES	12/09/2015

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:	AMBER DYE
Title:	ANNUITY PROCESSING
Phone Number:	5133582891
Email Address:	AMBER.DYE@53.COM