Notification of Changes for Business Entity
General Information
Business Entity Name:	ALLIANCE INSURANCE PARTNERS LLC
Incorporation / Formation Date:	04/28/2014
FEIN:	47-1897554
Ohio License Number:	1088715
NPN:	17387827
DBA / Trade Name:
State of Domicile:	AZ
County:	USA
Business Address
Address 1:	5425 EAST BELL RD SUITE 140
Address 2:
City:	SCOTTSDALE
State:	AZ
Zip:	85254
Phone:	602-427-4300
Fax:	602-385-8601
Business Web Site Address:	HTTP://WWW.ALLIANCEINSURANCEPARTNERS.COM
Business Email Address:	JOEL@ALLIANCEINSURANCEPARTNERS.COM
Mailing Address
Address 1:	5425 EAST BELL RD SUITE 140
Address 2:
City:	SCOTTSDALE
State:	AZ
Zip:	85254
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

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:	MARIE CARAVANA
Title:	CSR/ADMINISTRATOR
Phone Number:	602-427-4300
Email Address:	MARIE@ALLIANCEINSURANCEPARTNERS.COM