Notification of Changes for Business Entity
General Information
Business Entity Name:	MARTINEAU MILLER FRAZIER AGENCY
Incorporation / Formation Date:
FEIN:	341669929
Ohio License Number:	1712
NPN:	957704
DBA / Trade Name:
State of Domicile:	OH
County:	LUCAS
Business Address
Address 1:	3231 CENTRAL PARK WEST STE 112
Address 2:
City:	TOLEDO
State:	OH
Zip:	43617
Phone:	419-537-1536
Fax:	419-537-1583
Business Web Site Address:
Business Email Address:	NAIA@MMFINSURANCE.COM
Mailing Address
Address 1:	MARTINEAU MILLER FRAZIER AGENCY
Address 2:	3132 CENTRAL PARK W STE 112
City:	TOLEDO
State:	OH
Zip:	43617
Indicate the type of change you are seeking
Address Change:	YES
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:	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)
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:	NAIA K. MILLER
Title:	OFFICE MGR./BOOKKEEPER
Phone Number:	419-537-1536
Email Address:	NAIA@MMFINSURANCE.COM