Notification of Changes for Business Entity
General Information
Business Entity Name:	PM TITLE, LLC
Incorporation / Formation Date:	03/11/2014
FEIN:	464924146
Ohio License Number:	1020273
NPN:	17214323
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	3800 BROADWAY
Address 2:
City:	GROVE CITY
State:	OH
Zip:	43123
Phone:	740-313-7345
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3800 BROADWAY
Address 2:
City:	GROVE CITY
State:	OH
Zip:	43123
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
MELANIE RAE STRAPP	TITLE INSURANCE MARKETING REP			YES	12/31/16
TYLER MATTHEW CUPP	TITLE INSURANCE MARKETING REP			YES	12/31/16

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)	YES
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	ATTORNEY AT LAW

Submitted By
Submitted By:	MARK S. MILLER
Title:	CO-OWNER
Phone Number:	740-313-7345
Email Address:	MMILLER@PM-TITLE.COM