Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSOCIATED INSURANCE & FINANCIAL SERVICES LLC
Incorporation / Formation Date:	08/16/2001
FEIN:	233092859
Ohio License Number:	35970
NPN:	6407507
DBA / Trade Name:	GANNON ASSOCIATES
State of Domicile:	PA
County:	BRADFORD
Business Address
Address 1:	28 MAIN STREET
Address 2:	P.O. BOX 327
City:	TOWANDA
State:	PA
Zip:	18848
Phone:	570-265-3197
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P.O. BOX 327
Address 2:
City:	TOWANDA
State:	PA
Zip:	18848
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
TAMMIE L. TIFFANY	ACCOUNT MANAGER	7144300	YES		9/6/16

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:	JESSICA ROOT
Title:	LICENSING COORDINATOR
Phone Number:	570-265-3197
Email Address:	JROOT@GANNONASSOCIATES.COM