Notification of Changes for Business Entity
General Information
Business Entity Name:	SECURE ADMINISTRATIVE SOLUTIONS
Incorporation / Formation Date:
FEIN:	46-4813559
Ohio License Number:	1085076
NPN:
DBA / Trade Name:
State of Domicile:	UT
County:	SALT LAKE
Business Address
Address 1:	1405 W 2200 S
Address 2:
City:	SALT LAKE CITY
State:	UT
Zip:	84119
Phone:	3853311844
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1405 W 2200 S
Address 2:
City:	SALT LAKE CITY
State:	UT
Zip:	84119
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
KENNETH KING	MANAGER	144-72-3937	YES		06/19/2018
MICHAEL MAUGHAN	PRESIDENT	529-31-3237	YES		01/01/2018

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:	JOELLE BOHLENDER
Title:	COMPLIANCE ANALYST III
Phone Number:	385-331-1844
Email Address:	JBOHLENDER@SSLCO.COM