Notification of Changes for Business Entity
General Information
Business Entity Name:	JAMES F. BLEW AGENCY
Incorporation / Formation Date:
FEIN:	211523602
Ohio License Number:	978535
NPN:	8002740
DBA / Trade Name:
State of Domicile:	PA
County:	BUTLER
Business Address
Address 1:	220 SOUTH MAIN STREET
Address 2:
City:	ZELIENOPLE
State:	PA
Zip:	16063
Phone:	7244530717
Fax:
Business Web Site Address:
Business Email Address:	KCRAWFORD1@ALLSTATE.COM
Mailing Address
Address 1:	109 ENDRESS DRIVE
Address 2:
City:	ZELIENOPLE
State:	PA
Zip:	16063
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	YES	Old Business Entity Name:	ALLSTATE INS - PAUL BLINN AGEN
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

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:	KRISTIN CRAWFORD
Title:	LICENSED SALES PRODUCER
Phone Number:	7244524606
Email Address:	KCRAWFORD1@ALLSTATE.COM