Notification of Changes for Business Entity
General Information
Business Entity Name:	HAMILTON INSURANCE GROUP
Incorporation / Formation Date:
FEIN:	341704045
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	RICHLAND
Business Address
Address 1:	1669 LEXINGTON AVE. STE B
Address 2:
City:	MANSFIELD
State:	OH
Zip:	44907
Phone:	4195264700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1669 LEXINGTON AVE. STE B
Address 2:
City:	MANSFIELD
State:	OH
Zip:	44907
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	O'DELL INSURANCE AGENCY
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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)
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:	MICHAEL HAMILTON
Title:	VICE PRESIDENT
Phone Number:	4195264700
Email Address:	MICHAEL@HAMILTONINS.NET