Notification of Changes for Business Entity
General Information
Business Entity Name:	A J AMER AGENCY INC
Incorporation / Formation Date:	02/20/1965
FEIN:	340962612
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	SUMMIT
Business Address
Address 1:	3700 EMBASSY PARKWAY #160
Address 2:
City:	AKRON
State:	OH
Zip:	44333
Phone:	3306659966
Fax:	3306657979
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3700 EMBASSY PARKWAY #160
Address 2:
City:	AKRON
State:	OH
Zip:	44333
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
DAWN L. ZEITLER	AGENT	1823995		YES	02/01/1998
ELIZABETH A KELLER	AGENT	2775805		YES	06/22/2005
JEAN S. AMER	VICE PRESIDENT	1839110		YES	09/01/2004
KATE MARIE BANG	AGENT	7324339		YES	02/28/2004
KATHLEEN M. HENDERSON	AGENT	1739214		YES	02/01/1998
MARK H. SWIHART	AGENT	7331797		YES	11/03/2005
OSCAR A HUNSICKER JR	SECRETARY	CANDIDATE		YES	01/10/2002
T BRADFORD AMER	EMPLOYEE	814452		YES	01/01/1994

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:	HAMILTON S. AMER
Title:	C. E. O.
Phone Number:	3306659966
Email Address:	CONNIE@AMERINSURANCE.COM