Notification of Changes for Business Entity
General Information
Business Entity Name:	FORGE FINANCIAL SERVICES INC.
Incorporation / Formation Date:
FEIN:	341420592
Ohio License Number:	1588
NPN:	2438596
DBA / Trade Name:	JAMES & SONS
State of Domicile:	OH
County:	MAHONING
Business Address
Address 1:	4444 MARKET STREET
Address 2:
City:	YOUNGSTOWN
State:	OH
Zip:	44512
Phone:	330-788-5051
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4444 MARKET STREET
Address 2:
City:	YOUNGSTOWN
State:	OH
Zip:	44512
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
AMY PATRICE WITMER	AGENT	3691996		YES	12/01/2015
ERIC DEZEE	AGENT	2209919	YES		12/01/2015
MICHELLE DANIELS	AGENT	2515031	YES		12/01/2015
DANA LESNIAK	AGENT	17617704	YES		12/01/2015

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:	STEPHENIE MARONI
Title:	OPERATIONS MANAGER
Phone Number:	330-788-5051
Email Address:	SMARONI@JAMESANDSONSINS.COM