| Notification of Changes for Business Entity |
| General Information | |
| Business Entity Name: | MECHANICS BANK |
| Incorporation / Formation Date: | |
| FEIN: | 34-0394160 |
| Ohio License Number: | |
| NPN: | |
| DBA / Trade Name: | |
| State of Domicile: | OH |
| County: | RICHLAND |
| Business Address | |
| Address 1: | 2 SOUTH MAIN STREET |
| Address 2: | |
| City: | MANSFIELD |
| State: | OH |
| Zip: | 44902 |
| Phone: | 419-524-0831 |
| Fax: | |
| Business Web Site Address: | |
| Business Email Address: | |
| Mailing Address | |
| Address 1: | 2 SOUTH MAIN STREET |
| Address 2: | |
| City: | MANSFIELD |
| State: | OH |
| Zip: | 44902 |
| | |
| 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 |
| | |
| Members, Owners, Partners, Officers and Directors |
| Name | Title | Identifying # | Add | Delete | Eff. Date |
| NATHAN T. MASTERS | ASSISTANT VICE PRESIDENT | 289-92-2192 | YES | | 2/7/2018 |
| DEANNE M. MORELL | ASSISTANT VICE PRESIDENT | 289-58-5868 | YES | | 2/7/2018 |
| MARY A. WILLIAMS | ASSISTANT VICE PRESIDENT | 290-88-0825 | YES | | 2/7/2018 |
| ROSELL S. BOLESKY | ASSISTANT SECRETARY-TREASURER | 301-08-8347 | YES | | 2/7/2018 |
| COLLEN A. CARTER | ASSISTANT SECRETARY-TREASURER | 271-96-2594 | YES | | 2/7/2018 |
| NICHOLEL. DINGUS | ASSISTANT SECRETARY-TREASURER | 290-72-0269 | YES | | 2/7/2018 |
| STACEY M. MASSIE-CREEL | ASSISTANT SECRETARY-TREASURER | 299-86-7256 | YES | | 2/7/2018 |
| MEGAN A. MCCARRICK | ASSISTANT SECRETARY-TREASURER | 270-02-5574 | YES | | 2/7/2018 |
| JESSICA D. SHAUM | ASSISTANT SECRETARY-TREASURER | 286-92-6455 | YES | | 2/7/2018 |
| JASON PAINLEY | ASSISTANT SECRETARY-TREASURER | 279-74-5105 | YES | | 2/7/2018 |
| 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 | |