Notification of Changes for Business Entity
General Information
Business Entity Name:	HALL-GREEN AGENCY
Incorporation / Formation Date:
FEIN:	31-1629701
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	PORTAGE
Business Address
Address 1:	146 N DEPEYSTER
Address 2:
City:	KENT
State:	OH
Zip:	44240
Phone:	3306735873
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 398
Address 2:
City:	KENT
State:	OH
Zip:	44240
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
MARK DANIEL YANKOVICH	PRODUCER	3241240	YES		12/30/1999
SUSAN RENE TRIPEPI	EMPLOYEE	17978883	YES		06/17/2016
LAURA CATHERINE VONSTEIN	EMPLOYEE	4587354	YES		02/02/2012
ANDREW JAMES OBRAZA	EMPLOYEE	7324390	YES		01/25/2006
JEANNE ANN KOTIS	EMPLOYEE	5111982		YES	08/01/2016
GARY S URCHEK	EMPLOYEE	2333851		YES	12/31/2015
DAVID H GREEN	EMPLOYEE	519307		YES	03/22/2002

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?	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:	MICHAEL FINLEY
Title:	OWNER
Phone Number:	3306735873
Email Address:	HALL-GREEN@HALL-GREEN.COM