Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
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
SHELIA LEWIS	PRODUCER	17028789	YES		03/04/2016
TANEISHA THAXTON	PRODUCER	15891851	YES		03/04/2016
JERMAINE RAINFORD	PRODUCER	17021980	YES		03/04/2016
LINDA GHALIEH	PRODUCER	12805054	YES		03/04/2016
MARIA MOATS	PRODUCER	17038429	YES		03/04/2016
LAURA BIRMINGHAM	PRODUCER	15031389	YES		03/04/2016
DWIGHT DWYER	PRODUCER	17253113	YES		03/04/2016
JANAE MCAFEE	PRODUCER	17048834	YES		03/04/2016
AVA GREGORY	PRODUCER	16969638	YES		03/04/2016
VALERIE POSEY	PRODUCER	17245718	YES		03/04/2016
DAVID JAMES JR	PRODUCER	7090872	YES		03/04/2016
JOHN KAKLIS	PRODUCER	3564774	YES		03/04/2016
SHERRY MOTEN	PRODUCER	16960400	YES		03/04/2016
EUNIDE PIERRE	PRODUCER	17356933	YES		03/04/2016
STEPHANIE WILLIAMS	PRODUCER	17038346	YES		03/04/2016

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)
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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM