Notification of Changes for Business Entity
General Information  
Business Entity Name: RICH AND CARTMILL INC
Incorporation / Formation Date:  
FEIN: 730737979
Ohio License Number: 29627
NPN: 1627947
DBA / Trade Name:  
State of Domicile: OK
County: TULSA
Business Address  
Address 1: 2738 EAST 51ST STREET, STE. 400
Address 2:  
City: TULSA
State: OK
Zip: 74105
Phone: 9187438811
Fax: 9187448429
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 2738 E 51ST ST STE 400
Address 2:  
City: TULSA
State: OK
Zip: 74105
   
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
ROBERT MARK BLACKSTEN OFFICER 500588260   YES 04/10/2018
RAYMOND M HALE OFFICER 429861740   YES 04/10/2018
JEFF CLYMER OFFICER 447561708   YES 04/10/2018
BEN F GORRELL, JR. OFFICER 440485137   YES 04/10/2018
CHRISTOPHER WEBB VICE PRESIDENT 500908927 YES   04/10/2018
VAUGHN P. GRAHAM JR. VICE PRESIDENT 448902922 YES   04/10/2018
AUSTIN K. GREENSHAW VICE PRESIDENT 442909535 YES   04/10/2018
CLAYTON HOWELL VICE PRESIDENT 4401945073 YES   04/10/2018
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: CHRISTY KRICK
Title: LICENSING ADMINISTRATOR
Phone Number: 8124942472
Email Address: CKRICK@SUPPORTIVEIS.COM