Notification of Changes for Business Entity
General Information
Business Entity Name:	FIRST NATIONWIDE TITLE AGENCY, LLC
Incorporation / Formation Date:
FEIN:	45-5292110
Ohio License Number:	1149874
NPN:	16838534
DBA / Trade Name:
State of Domicile:	NY
County:	NEW YORK
Business Address
Address 1:	220 E 42ND ST
Address 2:
City:	NEW YORK
State:	NY
Zip:	10017
Phone:	860-571-3104
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	400 EXECUTIVE BLVD, 4TH FL
Address 2:
City:	SOUTHINGTON
State:	CT
Zip:	06489
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
BARRY MOSES	SECRETARY	299-50-5324	YES		03/22/2018
STEVEN NAPOLITANO	PRESIDENT	051-62-3572	YES		03/22/2018
HARRY SCHLACHTER	TREASURER	074-50-6936	YES		03/22/2018

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)
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?
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:	CATHY KIMMEY
Title:	LICENSING SPECIALIST
Phone Number:	972-788-6811
Email Address:	PRODUCER.LICENSING@AMTRUSTGROUP.COM