Notification of Changes for Business Entity
General Information
Business Entity Name:	PEOPLES INSURANCE AGENCY, LLC
Incorporation / Formation Date:
FEIN:	311398962
Ohio License Number:	2671
NPN:	2212599
DBA / Trade Name:
State of Domicile:	OH
County:	WASHINGTON
Business Address
Address 1:	138 PUTNAM ST
Address 2:
City:	MARIETTA
State:	OH
Zip:	45750
Phone:	740-376-7279
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 210
Address 2:
City:	MARIETTA
State:	OH
Zip:	45750
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
ANGELA GRACE	AGENT	1799197		YES	08/01/2017
THOMAS COLE PHIPPS	VICE PRESIDENT	1543606		YES	01/01/2017
MICHELLE GRIFFEN	AGENT/SECRETARY	1746439		YES	08/10/2017
PAUL A WEGLAGE	AGENT/PRESIDENT	1486661		YES	08/01/2017
TARA SHOEMAKER	AGENT	8731178		YES	01/01/2017
LORRAINE SWOGGER	AGENT	1088638	YES		01/01/2017
HOPE HARRELL	AGENT	17033261	YES		01/01/2016
SHELLY HUGHES	AGENT	18366361	YES		03/01/2017
KATHLEEN EDMAN	AGENT	6383006	YES		01/01/2016
TIFFANY DEMASTERS	AGENT	8659705	YES		01/01/2017
CLAIRE EVANS	AGENT	17839094	YES		03/01/2017

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:	AMY JO MIRACLE
Title:	LICENSING/ACCOUNTING MGR
Phone Number:	740-376-7279
Email Address:	AMYJO.MIRACLE@PEBO.COM