Notification of Changes for Business Entity
General Information
Business Entity Name:	STEFFEY HATOWAY INSURANCE LLC
Incorporation / Formation Date:	12/29/2000
FEIN:	352128408
Ohio License Number:	38018
NPN:	7744853
DBA / Trade Name:
State of Domicile:	IN
County:	MARION
Business Address
Address 1:	8365 KEYSTONE CROSSING STE 202
Address 2:
City:	INDIANAPOLIS
State:	IN
Zip:	46240
Phone:	317-334-3743
Fax:	317-472-9380
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8365 KEYSTONE CROSSING STE 202
Address 2:
City:	INDIANAPOLIS
State:	IN
Zip:	46240
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	STEFFEY INSURANCE AGENCY LLC
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
PETER M STEFFEY	MEMBER	1447682	YES		1/1/2017

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:	PETER M STEFFEY
Title:	MEMBER / PRINCIPAL
Phone Number:	317-334-3743
Email Address:	MIKE@STEFFEYINS.COM