Notification of Changes for Business Entity
General Information
Business Entity Name:	PINNACLE TRAVEL & TOURS LLC
Incorporation / Formation Date:
FEIN:	26-1216334
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	LUCAS
Business Address
Address 1:	104 PINNACLE DR.
Address 2:
City:	FREMONT
State:	OH
Zip:	43420
Phone:	4193322424
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	318 LINCOLN ST.
Address 2:
City:	FREMONT
State:	OH
Zip:	43420
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
GREGORY KUNS	OWNER
CHRISTOPHER J. DOUGHERTY	PRODUCER	16955690	YES		6/10/2015

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)	YES
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?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	COMPANY;PINNACLE TRAVEL & TOURS NATURE; TRAVEL INDUSTRY

Submitted By
Submitted By:	CHRISTOPHER J. DOUGHERTY
Title:	TRAVEL COORDINATOR/ MARKETING DIRECTOR
Phone Number:	4193452512
Email Address:	CDOUGHERTY36@YAHOO.COM