Notification of Changes for Business Entity
General Information
Business Entity Name:	METRO AREA GROUP INSURANCE CONSULTANTS
Incorporation / Formation Date:
FEIN:	34-1663858
Ohio License Number:	964
NPN:	2557696
DBA / Trade Name:
State of Domicile:	OH
County:	DELAWARE
Business Address
Address 1:	14-B E. CHERRY STREET
Address 2:	PO BOX 1130
City:	SUNBURY
State:	OH
Zip:	43074
Phone:	7409653560
Fax:
Business Web Site Address:
Business Email Address:	BILL@MAGICHIS.COM
Mailing Address
Address 1:	14-B E. CHERRY STREET
Address 2:	PO BOX 1130
City:	SUNBURY
State:	OH
Zip:	43074
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
COLLEEN METRO AREA GROUP INSUR

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:	M. COLLEEN LYDEN
Title:	ASSISTANT
Phone Number:	740-965-3560
Email Address:	COLLEEN@MAGICHIS.COM