Notification of Changes for Business Entity
General Information
Business Entity Name:	LENDMARK FINANCIAL SERVICES LLC
Incorporation / Formation Date:	07/31/1996
FEIN:	582257419
Ohio License Number:	1090627
NPN:	8415594
DBA / Trade Name:
State of Domicile:	GA
County:	NEWTON
Business Address
Address 1:	2118 USHER STREET
Address 2:
City:	COVINGTON
State:	GA
Zip:	30014
Phone:	6786256500
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2118 USHER STREET
Address 2:
City:	COVINGTON
State:	GA
Zip:	30014
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
JULIE CANON	MGR	1089670	YES		4/1/16
MARK G SCHMIDT	MGR	1707963	YES		4/1/16
TIMOTHY M VAN BUREN	MGR	14780750	YES		4/1/16
TINA M BROWN	CSR	10218993	YES		4/1/16
TANYA M PATTON	CSR	8836051	YES		4/1/16
KRISTINA L SHOWALTER	MGR	8373515	YES		4/1/16
SARAH D ERVIN	MGR	16990720	YES		4/1/16
CHELSEA R PUCKETT	CSR	17675520	YES		4/1/16
WILLIAM A MITCHELL	MGR	1776779	YES		4/1/16
TRISA R SHAW	CSR	17675519	YES		4/1/16
LINCOLN P BOSSERT	MGR	2342445	YES		4/1/16
MATTHEW R SALMONS	CSR	1861981	YES		4/1/16
CORTNEE M SMITH	CSR	17549536	YES		4/1/16

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

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