Notification of Changes for Business Entity
General Information
Business Entity Name:	OMNI TITLE LLC
Incorporation / Formation Date:
FEIN:	20-1076592
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	737 BOLIVAR ROAD, SUITE 210
Address 2:
City:	CLEVELAND
State:	OH
Zip:	44115
Phone:	(440) 578-7787
Fax:	(440) 578-7788
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	737 BOLIVAR ROAD, SUITE 210
Address 2:
City:	CLEVELAND
State:	OH
Zip:	44115
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
BONNIE KORPONIC	TITLE OFFICER	1800241	YES		7/1/17
CARA JO PYLES-DYE	TITLE OFFICER	3241544	YES		7/1/17

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DAVID N. DEROBERTS	TIMR	300-44-0534	YES		7/1/17
MICHELLE L. TROHA	ADMINISTRATOR	285-84-1933	YES		7/1/17

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:	MICHELLE L. TROHA
Title:	ADMINISTRATOR
Phone Number:	(440) 266-7777
Email Address:	MTROHA@SIKORALAW.COM