Notification of Changes for Business Entity
General Information
Business Entity Name:	R. M. STEPHENS & CO. INCORPORATED
Incorporation / Formation Date:
FEIN:	131345400
Ohio License Number:	37120
NPN:
DBA / Trade Name:
State of Domicile:	NY
County:	WESTCHESTER
Business Address
Address 1:	1 NORTH BROADWAY
Address 2:	STE 414
City:	WHITE PLAINS
State:	NY
Zip:	10601
Phone:	2126825586
Fax:	2126825589
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1 NORTH BROADWAY
Address 2:	STE 414
City:	WHITE PLAINS
State:	NY
Zip:	10601
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:	ALISON COTTON
Title:	CLIENT SERVICES, ILSA
Phone Number:	254-729-6193
Email Address:	ACOTTON@ILSAINC.COM