Notification of Changes for Business Entity
General Information
Business Entity Name:	DAN SERVICES INC
Incorporation / Formation Date:
FEIN:	56-2089710
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NC
County:	DURHAM
Business Address
Address 1:	6 WEST COLONY PLACE
Address 2:
City:	DURHAM
State:	NC
Zip:	27705
Phone:	919-684-2948
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	6 WEST COLONY PLACE
Address 2:
City:	DURHAM
State:	NC
Zip:	27705
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
AUSTEN MASSEY	AGENT	18853682	YES		10/11/2018

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)
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:	ROBIN DOLES
Title:	SECRETARY
Phone Number:	919-684-2948
Email Address:	RDOLES@DAN.ORG