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:	NJ
County:	BERGEN
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
DANIEL GLASS	PRODUCER	16218218	YES		04/25/2016
DANIEL PASCAZIO	PRODUCER	16790495	YES		04/25/2016
DANIEL REISMILLER	PRODUCER	17122127	YES		04/25/2016
DANIEL REYNOLDS	PRODUCER	537942	YES		04/25/2016
DANIELLE AMIDON	PRODUCER	16105948	YES		04/25/2016
DANIELLE GRAHAM	PRODUCER	16519054	YES		04/25/2016
DANIELLE HARVEY	PRODUCER	17699899	YES		04/25/2016
DANIELLE WILSON	PRODUCER	17078781	YES		04/25/2016
DARIUS LOWE	PRODUCER	17064480	YES		04/25/2016
DARLENE WEIMZIERL	PRODUCER	16624866	YES		04/25/2016
DAVID DESTROOPER	PRODUCER	16733167	YES		04/25/2016
DAVID GUERRERO	PRODUCER	16791676	YES		04/25/2016
DAVID IVY	PRODUCER	17362230	YES		04/25/2016
DAVID MORALES	PRODUCER	10347565	YES		04/25/2016
DAVID PANTING	PRODUCER	17561891	YES		04/25/2016

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