Notification of Changes for Business Entity
General Information
Business Entity Name:	DEANS & HOMER
Incorporation / Formation Date:
FEIN:	94-1072984
Ohio License Number:	24796
NPN:	78989
DBA / Trade Name:
State of Domicile:	CA
County:	UNITED STATES
Business Address
Address 1:	340 PINE STREET
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94104
Phone:	7024921282
Fax:
Business Web Site Address:
Business Email Address:	LICENSING@DEANSHOMER.COM
Mailing Address
Address 1:	340 PINE STREET
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94104
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
RUBY ROBLES	RENTER'S INSURANCE SPECIALIST	10987011	YES		122117

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:	TYLER HOWARD
Title:	LICENSING MANAGER
Phone Number:	7024921282
Email Address:	TYLER@DEANSHOMER.COM