Notification of Changes for Business Entity
General Information
Business Entity Name:	NFS INSURANCE AGENCY LLC
Incorporation / Formation Date:	12/31/2016
FEIN:	36-4824727
Ohio License Number:	1096133
NPN:	17830119
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	4640 ADMIRALTY WAY, SUITE 200
Address 2:
City:	MARINA DEL REY
State:	CA
Zip:	90292
Phone:	310-410-9150
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4640 ADMIRALTY WAY, SUITE 200
Address 2:
City:	MARINA DEL REY
State:	CA
Zip:	90292
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	SENIORS UNITED INS AGENCY, INC
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	HENRY HATTEMER
Title:	SECRETARY
Phone Number:	310-440-9150
Email Address:	HANK.HATTEMER@NEILSONFS.COM