Notification of Changes for Business Entity
General Information
Business Entity Name:	INDIANA LAND TITLE
Incorporation / Formation Date:
FEIN:	42-1695863
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	IN
County:	IN
Business Address
Address 1:	131 ELM ST.
Address 2:	#11
City:	LAWRENCEBURG
State:	IN
Zip:	47025
Phone:	812-537-4105
Fax:
Business Web Site Address:
Business Email Address:	BILL@INDIANALANDTITLE.NET
Mailing Address
Address 1:	131 ELM ST.
Address 2:	#11
City:	LAWRENCEBURG
State:	IN
Zip:	47025
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:	INDIANA LAND TITLE
New DBA/Trade Name:	YES	New DBA/Trade Name:	OKI TITLE
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
KACY HOWLAND	EMPLOYEE	18778030	YES		06/22/2018
WILLIAM THOMPSON-WERNER	DIRECTOR	280661769	YES		06/22/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
WILLIAM THOMPSON-WERNER

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:	WILLIAM THOMPSON-WERNER
Title:	DIRECTOR
Phone Number:	812-537-4105
Email Address:	BILL@INDIANALANDTITLE.NET