Notification of Changes for Business Entity
General Information
Business Entity Name:	BRAWNER AGENCY, LLC
Incorporation / Formation Date:
FEIN:	77-0661762
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	27211 WOLF ROAD
Address 2:
City:	BAY VILLAGE
State:	OH
Zip:	44140
Phone:	4408921700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	27211 WOLF ROAD
Address 2:
City:	BAY VILLAGE
State:	OH
Zip:	44140
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	WESTSHORE AGENCY
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
GREG BRAWNER	BRAWNER AGENCY, LLC MEMBER	77-0661762	YES		09/11/2006

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	N/A

Submitted By
Submitted By:	GREG BRAWNER
Title:	BRAWNER AGENCY, LLC MEMBER
Phone Number:	4408921700
Email Address:	GREGBRAWNER@ALLSTATE.COM