Notification of Changes for Business Entity
General Information
Business Entity Name:	HTA FINANCIAL SERVICES, INC.
Incorporation / Formation Date:
FEIN:	208112101
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	PA
County:	CHESTER
Business Address
Address 1:	21 W WASHINGTON STREET
Address 2:	SUITE A
City:	WEST CHESTER
State:	PA
Zip:	19380
Phone:	6104306650
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	21 W WASHINGTON STREET
Address 2:	SUITE A
City:	WEST CHESTER
State:	PA
Zip:	19380
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
TRACY RUSSO	PRINCIPLE	208584914	YES		11/03/2016

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:	TRACY RUSSO
Title:	PRINCIPLE
Phone Number:	6104306650
Email Address:	TRUSSO@HTAFINANCIAL.COM