Notification of Changes for Business Entity
General Information
Business Entity Name:	ROBERT TAYLOR COMPANIES
Incorporation / Formation Date:
FEIN:	90-0119652
Ohio License Number:	30248
NPN:	7976938
DBA / Trade Name:	ROBERT TAYLOR INSURANCE
State of Domicile:	OH
County:	LORAIN
Business Address
Address 1:	2063 N RIDGE RD E
Address 2:
City:	LORAIN
State:	OH
Zip:	44055
Phone:	(440) 277-5191
Fax:	(440) 277-8494
Business Web Site Address:	WWW.ROBERTTAYLORINSURANCE.COM
Business Email Address:	SAVE@ROBERTTAYLORINSURANCE.COM
Mailing Address
Address 1:	2063 N RIDGE RD E
Address 2:
City:	LORAIN
State:	OH
Zip:	44055
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
ROBERT J. TAYLOR	RDA	2769566	YES		10/30/2017
JEFFREY C. RIPKING	RDA	8067422	YES		10/30/2017

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:	ROBERT J. TAYLOR
Title:	OWNER/PRESIDENT
Phone Number:	(440) 653-3576
Email Address:	SAVE@ROBERTTAYLORINSURANCE.COM