Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BERGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
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
ALEAH HOUGH	PRODUCER	17303671		YES	04/15/2016
ANGELA POSTON	PRODUCER	16697400		YES	04/15/2016
ASHLEY YODER	PRODUCER	16967385		YES	04/15/2016
CODY MULHALL	PRODUCER	11875477		YES	04/15/2016
LISA LANE	PRODUCER	16274032		YES	04/15/2016
JERMAINE MARCO RAINFORD	PRODUCER	17021980		YES	04/15/2016
MUMHAMMAD BELL	PRODUCER	17041151		YES	04/15/2016
ROBERT EVANS	PRODUCER	9755168		YES	04/15/2016
CHANEL WEST	PRODUCER	17697641		YES	04/15/2016
DOUGLAS AIREY	PRODUCER	16599254		YES	04/15/2016

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)
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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM