Notification of Changes for Business Entity
General Information
Business Entity Name:	TORELL AVIATION INSURANCE AGENCY, INC.
Incorporation / Formation Date:
FEIN:	383862207
Ohio License Number:	956284
NPN:	16504602
DBA / Trade Name:
State of Domicile:	FL
County:	ST LUCIE
Business Address
Address 1:	18604 KITTY HAWK CT
Address 2:
City:	PORT ST LUCIE
State:	FL
Zip:	34987
Phone:	8443211777
Fax:	8443211777
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	18604 KITTY HAWK CT
Address 2:
City:	PORT ST LUCIE
State:	FL
Zip:	34987
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
BEVERLY COBB

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:	BEVERLY COBB
Title:	ALLIANCE-COMPLIANCE, INC / PRESIDENT
Phone Number:	8883727662
Email Address:	BEVERLY@ALLIANCE-COMPLIANCE.COM