Notification of Changes for Business Entity
General Information
Business Entity Name:	KEMBA FINANCIAL CREDIT UNION
Incorporation / Formation Date:
FEIN:	316034826
Ohio License Number:
NPN:	8406521
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	555 OFFICENTER PLACE
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
Phone:	614-235-2395
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 307370
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
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
AMY SIMON	AGENT	8459223		YES	06/03/15
JEFFREY BAGGOTT	AGENT	18202161		YES	11/18/16
GREG KASH	AGENT	18443437	YES		06/19/17
ADAM BUERGER	AGENT	18443400	YES		02/28/17
LINDSAY BELCHER	AGENT	9617980	YES		05/24/17
DERRICK WHITE	AGENT	18238076	YES		12/16/16
KAYLA FITZPATRICK	AGENT	18264945	YES		01/10/17
RYAN RANKIN	AGENT	18333468	YES		02/23/17
LORENA PEGUERO	AGENT	18371463	YES		04/10/17
SHEENA WILLIAMS	AGENT	18384267	YES		04/19/17
JOSHUA VRADENBURG	AGENT	18102428	YES		09/09/16
ANTHONY HESKETT	AGENT	18356191	YES		03/20/17
RACHEL CLIFFORD	AGENT	17326214	YES		04/06/17
SHELBY COLLINS	AGENT	18375079	YES		04/11/17

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)	YES
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?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	CREDIT UNION

Submitted By
Submitted By:	MARIA SMITH
Title:	EXECUTIVE ASSISTANT
Phone Number:	614-729-1399
Email Address:	MSMITH@KEMBA.ORG