Notification of Changes for Business Entity
General Information
Business Entity Name:	ABIS AGENCY LLC
Incorporation / Formation Date:
FEIN:	64-0955310
Ohio License Number:	36005
NPN:	9154316
DBA / Trade Name:
State of Domicile:	OH
County:	UNION
Business Address
Address 1:	PO BOX 98
Address 2:
City:	UNIONVILLE CENTER
State:	OH
Zip:	43077
Phone:	614-873-3333
Fax:	614-873-3133
Business Web Site Address:
Business Email Address:	NATE.BOERGER@ABISONLINE.COM
Mailing Address
Address 1:	PO BOX 98
Address 2:
City:	UNIONVILLE CENTER
State:	OH
Zip:	43077
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
NATHEN BOERGER	OFFICE MANAGER	7315986	YES		01/22/2016
ELIZABETH ANN SHADE	PRODUCER	17701257	YES		01/22/2016

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)
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?
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:	NATHEN BOERGER
Title:	OFFICE MANGER
Phone Number:	614-873-3333
Email Address:	NATE.BOERGER@ABISONLINE.COM