Notification of Changes for Business Entity
General Information
Business Entity Name:	STANDING STONE BANK
Incorporation / Formation Date:
FEIN:	311232089
Ohio License Number:	1014635
NPN:	4085201
DBA / Trade Name:
State of Domicile:	OH
County:	FAIRFIELD
Business Address
Address 1:	137 W WHEELING ST
Address 2:
City:	LANCASTER
State:	OH
Zip:	43130
Phone:	17406535115
Fax:
Business Web Site Address:
Business Email Address:	MBROWN@STANDINGSTONEBANK.COM
Mailing Address
Address 1:	137 W WHEELING ST
Address 2:
City:	LANCASTER
State:	OH
Zip:	43130
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DAVID LIFER	DIRECTOR	297327288		YES	6/16/2016
ROBERT CLAYPOOL	DIRECTOR	271822828	YES		9/15/2016
CATHY BITLER	DIRECTOR	296664407	YES		2/18/2016

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:	MARTA BROWN
Title:	CFO
Phone Number:	7404752598
Email Address:	MBROWN@STANDINGSTONEBANK.COM