Notification of Changes for Business Entity
General Information
Business Entity Name:	NEW CINGULAR WIRELESS PCS, LLC
Incorporation / Formation Date:	10/20/1994
FEIN:	22-3330080
Ohio License Number:	964893
NPN:	8203073
DBA / Trade Name:
State of Domicile:	DE
County:	USA
Business Address
Address 1:	1025 LENOX PARK BLVD
Address 2:
City:	ATLANTA
State:	GA
Zip:	30319
Phone:	816-237-3139
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11460 TOMAHAWK CREEK PKWY
Address 2:	STE 300
City:	LEAWOOD
State:	KS
Zip:	66211
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
THOMAS E. HANSON	ASST TREASURER	219-82-0712		YES	9/22/17
JENNIFER DE LA TORRE	ASST TREASURER	464-43-7480	YES		9/22/17

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:	JENNIFER DE LA TORRE
Title:	ASSISTANT TREASURER
Phone Number:	816-237-3139
Email Address:	NCWPCS@ASURION.COM