Notification of Changes for Business Entity
General Information
Business Entity Name:	STEVE AUSTINS AUTO GROUP INC
Incorporation / Formation Date:
FEIN:	34-1032390
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	LOGAN
Business Address
Address 1:	2500 US 68 SOUTH
Address 2:	PO BOX 247
City:	BELLEFONTAINE
State:	OH
Zip:	43311
Phone:	9375923015
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 247
Address 2:
City:	BELLEFONTAINE
State:	OH
Zip:	43311
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 OSBORNE	AGENT	1122205	YES		03/01/2016

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:	STEVEN H AUSTIN
Title:	PRESIDENT
Phone Number:	9375923015
Email Address:	STEVENHAUSTIN.YAHOO.COM