Notification of Changes for Business Entity
General Information
Business Entity Name:	HILL INS SERVICES LLC
Incorporation / Formation Date:	7/17/2001
FEIN:	86-1016262
Ohio License Number:	29189
NPN:	7306355
DBA / Trade Name:
State of Domicile:	AZ
County:	MARICOPA
Business Address
Address 1:	14301 N 87TH STREET #115
Address 2:
City:	SCOTTSDALE
State:	AZ
Zip:	85260
Phone:	480-368-5222
Fax:	480-368-1862
Business Web Site Address:	WWW.HILL-INS.COM
Business Email Address:	PHILL@HILL-INS.COM
Mailing Address
Address 1:	14301 N 87TH STREET #115
Address 2:
City:	SCOTTSDALE
State:	AZ
Zip:	85260
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:	PATTI HILL
Title:	SECRETARY
Phone Number:	480-368-5222
Email Address:	PHILL@HILL-INS.COM