Notification of Changes for Business Entity
General Information
Business Entity Name:	HYLANT GROUP, INC.
Incorporation / Formation Date:
FEIN:	34-1880366
Ohio License Number:	23894
NPN:	3244034
DBA / Trade Name:
State of Domicile:	OH
County:	LUCAS
Business Address
Address 1:	811 MADISON AVENUE
Address 2:
City:	TOLEDO
State:	OH
Zip:	43604
Phone:	419-255-1020
Fax:	419-255-7557
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	811 MADISON AVENUE
Address 2:
City:	TOLEDO
State:	OH
Zip:	43604
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
EVAN N. PROCACCINI	AGENT	17894440	YES		07/30/2018

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:	JUDY K. WILSON
Title:	LICENSING DEPARTMENT SUPERVISOR
Phone Number:	419-255-1020
Email Address:	JUDY.WILSON@HYLANT.COM