Notification of Changes for Business Entity
General Information
Business Entity Name:	LAMAR ENTERPRISE INC. DBA LAMAR & LAMAR INSURANCE
Incorporation / Formation Date:
FEIN:	35-1971748
Ohio License Number:	1032335
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	BOONE
Business Address
Address 1:	120 N. LEBANON ST.
Address 2:
City:	LEBANON
State:	IN
Zip:	46052
Phone:	765-482-1480
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 723
Address 2:
City:	LEBANON
State:	IN
Zip:	46052
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
JEREMY LAMAR	PARTNER	1	YES		03/23/2017

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	N/A

Submitted By
Submitted By:	JEREMY LAMAR
Title:	PARTNER
Phone Number:	765-482-1480
Email Address:	JLAMAR@LAMAR-LAMAR.COM