Notification of Changes for Business Entity
General Information
Business Entity Name:	CALLOS RESOURCE LLC
Incorporation / Formation Date:
FEIN:	471070940
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	AKRON
Business Address
Address 1:	6140 PARKLAND BLVD.
Address 2:
City:	MAYFIELD HEIGHTS
State:	OH
Zip:	44124
Phone:	4404616000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1032 BOARDMAN-CANFIELD ROAD
Address 2:	SUITE 102
City:	YOUNGSTOWN
State:	OH
Zip:	44512
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
GEOFFREY LEWIS	SALES MANAGER	7365967		YES	05/01/2016

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:	SHARI MERDICH
Title:	CORPORATE BENEFITS SPECIALIST
Phone Number:	330-788-0336
Email Address:	SMERDICH@EBSOA.NET