Notification of Changes for Business Entity
General Information
Business Entity Name:	NORTHVIEW INSURANCE AGENCY INC.
Incorporation / Formation Date:	11/4/1986
FEIN:	31-1193707
Ohio License Number:	1195541
NPN:	7139820
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	671 SOUTH HIGH STREET
Address 2:
City:	COLUMBUS
State:	OH
Zip:	43206
Phone:	800-422-0550
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	671 SOUTH HIGH STREET
Address 2:
City:	COLUMBUS
State:	OH
Zip:	43206
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
GRANGE LIFE INSURANCE COMPANY	OWNER	71218		YES	8/13/2018
GRANGE MUTUAL CASUALTY COMPANY	OWNER	14060	YES		8/13/2018

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:	LAVAWN COLEMAN
Title:	EVP GENERAL COUNSEL SECRETARY
Phone Number:	6144452649
Email Address:	COLEMANL@GRANGEINSURANCE.COM