Notification of Changes for Business Entity
General Information
Business Entity Name:	ESI FINANCIAL LLC III
Incorporation / Formation Date:
FEIN:	200400764
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MI
County:	KENT
Business Address
Address 1:	2155 84TH STREET SW
Address 2:
City:	BYRON CENTER
State:	MI
Zip:	49315
Phone:	6165830800
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2155 84TH STREET SW
Address 2:
City:	BYRON CENTER
State:	MI
Zip:	49316
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
DEBORAH TIELL	PARTNER	1511925		YES	03/19/2007

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:	MARY BROUCEK
Title:	OFFICE MANAGER
Phone Number:	6165830800
Email Address:	MARYB@ESIFINANCIAL.COM