Notification of Changes for Business Entity
General Information
Business Entity Name:	ALTA RESOURCES CORP
Incorporation / Formation Date:
FEIN:	391830026
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	WI
County:	OUTAGAMIE
Business Address
Address 1:	120 N COMMERCIAL ST
Address 2:
City:	NEENAH
State:	WI
Zip:	54956
Phone:	8774642582
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	120 N COMMERCIAL ST
Address 2:
City:	NEENAH
State:	WI
Zip:	54956
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
LEAH R MCNALLY	RDA	1066772		YES	10/4/2016
DAVID H QUANDT	RDA	1087465	YES		10/4/2016

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)	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:	NGOSONG FONKEM
Title:	COMPLIANCE COUNSEL
Phone Number:	8774642582
Email Address:	NFONKEM@ALTARESOURCES.COM