Notification of Changes for Business Entity
General Information
Business Entity Name:	INDEPENDENT EQUINE AGENTS
Incorporation / Formation Date:
FEIN:	611221658
Ohio License Number:
NPN:	2110473
DBA / Trade Name:
State of Domicile:	KY
County:	JEFFERSON
Business Address
Address 1:	10234 SHELBYVILLE RD #2A
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40223
Phone:	5022456878
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	10234 SHELBYVILLE RD #2A
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40223
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
ERIN BROOKE MASON	RDA	7162818	YES		4-12-17
KRISTIE LYNN KNIGHT	RDA	328922		YES	4-12-17

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:	BETSY REITER
Title:	LICENSING COORDINATOR
Phone Number:	5022456878
Email Address:	BETSY@INDEPENDENTEQUINEAGENTS.COM