Notification of Changes for Business Entity
General Information
Business Entity Name:	COFFEY & COMPANY, INC.
Incorporation / Formation Date:
FEIN:	52-1758047
Ohio License Number:	28512
NPN:	2014692
DBA / Trade Name:
State of Domicile:	MD
County:	BALTIMORE
Business Address
Address 1:	225 SCHILLING CIRCLE
Address 2:	SUITE 260
City:	HUNT VALLEY
State:	MD
Zip:	21031
Phone:	410-785-1432
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	225 SCHILLING CIRCLE
Address 2:	SUITE 260
City:	HUNT VALLEY
State:	MD
Zip:	21031
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
DOLORES COFFEY	OWNER	218688407	YES		03/06/2017

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:	BRIANNE FRITZE
Title:	EXECUTIVE ASSISTANT
Phone Number:	41078501432
Email Address:	BFRITZE@COFFEYCO.COM