Notification of Changes for Business Entity
General Information
Business Entity Name:	US IMMIGRATION BONDS & INSURANCE SERVICES, INC.
Incorporation / Formation Date:	09/30/2013
FEIN:	463772036
Ohio License Number:	1020286
NPN:	17170048
DBA / Trade Name:
State of Domicile:	FL
County:	FLORIDA
Business Address
Address 1:	114 SW 10TH ST SUITE C
Address 2:
City:	FORT LAUDERDALE
State:	OH
Zip:	33315
Phone:	9545134611
Fax:	954-513-4617
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	114 SW 10TH ST SUITE C
Address 2:
City:	FORT LAUDERDALE
State:	FL
Zip:	33315
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
JEREMY A WOLF	RDA	8083019		YES	05/26/2016
RICHARD I WOLF	RDA	17924528	YES		05/26/2016

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)	NO
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?	NO
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:	RICHARD I WOLF
Title:	PRESIDENT
Phone Number:	9545134611
Email Address:	INFO@USIMMIGRATIONBONDS.COM