Notification of Changes for Business Entity
General Information
Business Entity Name:	EUBANKS LAWSON INSURANCE
Incorporation / Formation Date:	02/27/2008
FEIN:	26-2202429
Ohio License Number:	1121592
NPN:	10476186
DBA / Trade Name:
State of Domicile:	FL
County:	PINELLAS
Business Address
Address 1:	2906 MILL STREAM CT
Address 2:
City:	CLEARWATER
State:	FL
Zip:	33761
Phone:	7275514656
Fax:
Business Web Site Address:
Business Email Address:	BOB@ELIOHIO.COM
Mailing Address
Address 1:	2906 MILL STREAM CT
Address 2:
City:	CLEARWATER
State:	FL
Zip:	33761
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
ROBERT LAWSON	PRINCIPAL	NPN9705890	YES		8/10/16

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:	ROBERT LAWSON
Title:	PRINCIPAL AGENT, MEMBER
Phone Number:	(740) 286-4515
Email Address:	BOB@ELIOHIO.COM