Notification of Changes for Business Entity
General Information
Business Entity Name:	DF INSURANCE AGENCY LLC
Incorporation / Formation Date:	4/12/2016
FEIN:	300936918
Ohio License Number:	1109051
NPN:	17958382
DBA / Trade Name:	DTFS INSURANCE AGENCY LLC
State of Domicile:	OH
County:	RAMSEY
Business Address
Address 1:	1100 LANDMARK TOWERS 345 ST. PETER. ST.
Address 2:
City:	ST. PAUL
State:	MN
Zip:	55102
Phone:	6512655031
Fax:
Business Web Site Address:
Business Email Address:	HEATHER.CRAWFORD@GT-CS.COM
Mailing Address
Address 1:	1100 LANDMARK TOWERS 345 ST. PETER. ST.
Address 2:
City:	ST PAUL
State:	MN
Zip:	55102
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
BRYAN GARRY	DESIGANTED PRODUCER	1570076	YES		1/10/2017

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:	HEATHER CRAWFORD
Title:	SEN LICENSING COORDINATOR
Phone Number:	6053557072
Email Address:	HEATHER.CRAWFORD@GT-CS.COM