Notification of Changes for Business Entity
General Information
Business Entity Name:	ELITE ADVISORS EDGE
Incorporation / Formation Date:	09/10/2004
FEIN:	90-0194564
Ohio License Number:	1015487
NPN:	8292050
DBA / Trade Name:
State of Domicile:	MI
County:	LIVINGSTON
Business Address
Address 1:	1024 E GRAND RIVER AVE
Address 2:
City:	BRIGHTON
State:	MI
Zip:	48116
Phone:	(810)227-2557
Fax:	(810)227-2558
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1024 GRAND RIVER AVE
Address 2:
City:	BRIGHTON
State:	MI
Zip:	48116
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	MSM ELITE INC
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
RONALD BRIGGS JR.	PRODUCER	970344	YES		02/20/2015
NOEL C. VASQUEZ	PRODUCER	17368164	YES		10/01/2017
ROMMEL A. ANGULO GUDINO	PRODUCER	17771542	YES		11/05/2015
EUGENE CAGE	PRODUCER	14290363	YES		10/05/2017
CHRISTINE CONFALONE	PRODUCER	3540399	YES		01/01/2016
PAUL KITZROW	PRODUCER	8684872	YES		03/03/2011
MITCHELL W LYONS	PRODUCER	3954502	YES		01/01/2016

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
KRISTIN DOMBE-BRIGGS	PRINCIPLE	972774	YES		03/01/2017

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:	CAYLA MOORE
Title:	CONTRACTING DEPARTMENT
Phone Number:	8102272557
Email Address:	CMOORE@EAEDGE.COM