Notification of Changes for Business Entity
General Information
Business Entity Name:	OIA SERVICE CORPORATION
Incorporation / Formation Date:	12/21/2016
FEIN:	31-1452252
Ohio License Number:	1633
NPN:	2449562
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	600 CROSS POINTE ROAD
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
Phone:	(800) 555-1742
Fax:	(614) 552-3081
Business Web Site Address:	WWW.OHIOPIA.COM
Business Email Address:	GEORGE@OHIOINSURANCEAGENTS.COM
Mailing Address
Address 1:	600 CROSS POINTE ROAD
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
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
JUDY SIVY	AGENT	3116163	YES		12/21/16
DEBRA MAGERKO	RDA	1714988		YES	12/21/16

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
GEORGE HAENSZEL	SECRETARY			YES	1/1/17
GEORGE HAENSZEL	VICE PRESIDENT			YES	1/1/17
JUDY SIVY	DIRECTOR	3116163		YES	12/21/16
JEFF SMITH	DIRECTOR	17832705	YES		1/1/17
JEFF SMITH	SECRETARY	17832705	YES		1/1/17
JEFF SMITH	VICE PRESIDENT	17832705	YES		1/1/17
DANIEL HENERY	DIRECTOR	1926852	YES		12/21/16

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:	GEORGE HAENZSEL
Title:	SECRETARY/VICE PRESIDENT
Phone Number:	(614) 552-1742
Email Address:	GEORGE@OHIOINSURANCEAGENTS.COM