Notification of Changes for Business Entity
General Information
Business Entity Name:	IIAT SERVICES MGA, INC.
Incorporation / Formation Date:
FEIN:	472188002
Ohio License Number:
NPN:	17501456
DBA / Trade Name:
State of Domicile:	TX
County:	TRAVIS
Business Address
Address 1:	1115 SAN JACINTO BLVD. STE 100
Address 2:
City:	AUSTIN
State:	TX
Zip:	78701
Phone:	5124932431
Fax:
Business Web Site Address:
Business Email Address:	MREED@IIAT.ORG
Mailing Address
Address 1:	PO BOX 684487
Address 2:
City:	AUSTIN
State:	TX
Zip:	78701
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	LEVELFIRST
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

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:	KRISTY STARLING
Title:	LICENSING MANAGER
Phone Number:	2547296180
Email Address:	KSTARLING@ILSAINC.COM