Notification of Changes for Business Entity
General Information
Business Entity Name:	BAKER RISK MANAGEMENT
Incorporation / Formation Date:	03/24/2015
FEIN:	47-3460033
Ohio License Number:	1072465
NPN:	17548719
DBA / Trade Name:	BAKER INSURANCE GROUP AND BAKER FINANCIAL SERVICES
State of Domicile:	KY
County:	FAYETTE
Business Address
Address 1:	2039 REGENCY ROAD, SUITE 2
Address 2:
City:	LEXINGTON
State:	KY
Zip:	40503
Phone:	8592601792
Fax:	8442707548
Business Web Site Address:
Business Email Address:	PAUL@BAKERINSURE.COM
Mailing Address
Address 1:	2039 REGENCY ROAD, SUITE 2
Address 2:
City:	LEXINGTON
State:	KY
Zip:	40503
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
PAUL V. BAKER III	OWNER	8481413	YES		07122017

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:	PAUL V. BAKER III
Title:	OWNER
Phone Number:	8592601792
Email Address:	PAUL@BAKERINSURE.COM