Notification of Changes for Business Entity
General Information
Business Entity Name:	COSMOPOLITAN TITLE AGENCY, LLC
Incorporation / Formation Date:	11/01/2006
FEIN:	20-5869516
Ohio License Number:	33549
NPN:	8986793
DBA / Trade Name:
State of Domicile:	OH
County:	MONTGOMERY
Business Address
Address 1:	217 PARK DR
Address 2:
City:	DAYTON
State:	OH
Zip:	45410
Phone:	5023760700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	17 BURNHAM LANE
Address 2:
City:	VOORHEES
State:	NJ
Zip:	08043
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	BRB TRUST TITLE AGENCY, LLC
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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)	NO
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?	NO
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:	KATHERINE HANDZEL
Title:	MEMBER
Phone Number:	5023760700
Email Address:	KHANDZEL@BRBCOSMO.COM