Notification of Changes for Business Entity
General Information
Business Entity Name:	CAREY INSURANCE GROUP, INC.
Incorporation / Formation Date:	04/09/2018
FEIN:	452801969
Ohio License Number:	1106706
NPN:	16385944
DBA / Trade Name:
State of Domicile:	DE
County:	U.S.A.
Business Address
Address 1:	30618 DUPONT BLVD
Address 2:	SUITE 1
City:	DAGSBORO
State:	DE
Zip:	19939
Phone:	302-934-8383
Fax:	302-934-8395
Business Web Site Address:
Business Email Address:	BECKY@CAREYINSURANCEGROUP.NET
Mailing Address
Address 1:	30618 DUPONT BLVD
Address 2:
City:	DAGSBORO
State:	DE
Zip:	19939
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	SCOTT J. CAREY, INC.
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	YES	Old DBA/Trade Name:	CAREY INSURANCE GROUP, INC.
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
SCOTT J. CAREY	PRESIDENT	633192	YES		4/4/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
SCOTT J. CAREY	PRESIDENT	633192	YES		4/4/2018

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:	BECKY ROBINSON
Title:	LICENSE MANAGER
Phone Number:	410-651-3667
Email Address:	BECKY@CAREYINSURANCE GROUP.NET