Notification of Changes for Business Entity
General Information
Business Entity Name:	FX INSURANCE AGENCY, LLC
Incorporation / Formation Date:
FEIN:	32-2281892
Ohio License Number:	1152464
NPN:	8963028
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	3 BEAVER VALLEY RD
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19803
Phone:	302-252-2165
Fax:	302-252-2455
Business Web Site Address:
Business Email Address:	JEANNIE.MCLARNON@FARMERSINSURANCE.COM
Mailing Address
Address 1:	3 BEAVER VALLEY RD
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19803
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
JAY KREVER	AGENT	18941410	YES		12/19/2018
SCOTT KUYPERS	AGENT	1590876	YES		12/19/2018
ALEXANDRO LARA	AGENT	17454619	YES		12/19/2018
CHRISTINA LARA	AGENT	9857168	YES		12/19/2018
FRANK LARIVE	AGENT	1590878	YES		12/19/2018
SPENCER LEBOWITZ	AGENT	18932719	YES		12/19/2018
HEATHER LEONARD	AGENT	9675095	YES		12/19/2018
BARRY LEVITZ	AGENT	1590762	YES		12/19/2018
ANTOINE LOGAN	AGENT	8838426	YES		12/19/2018
BRITTANY LUKER	AGENT	18895741	YES		12/19/2018
SHELLI MCCREADIE STEMEN	AGENT	1001305	YES		12/19/2018
KARYNE MILLER	AGENT	18872710	YES		12/19/2018
CHRISTOPHER MILLS	AGENT	18980969	YES		12/19/2018
DWANA MORRIS	AGENT	11491658	YES		12/19/2018
NICHOLAS NELSON	AGENT	17620821	YES		12/19/2018

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:	REGINA M. MCLARNON
Title:	ASSISTANT SECRETARY
Phone Number:	302-252-2165
Email Address:	JEANNIE.MCLARNON@FARMERSINSURANCE.COM