Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
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
BRIEN SULLIVAN	PRODUCER	732016	YES		04/04/2016
BRUCE MAXWELL	PRODUCER	523730	YES		04/04/2016
BRYAN SHAFFER	PRODUCER	11407367	YES		04/04/2016
BRYAN TIDWELL	PRODUCER	17655264	YES		04/04/2016
CAREEN CASHMAN	PRODUCER	9633757	YES		04/04/2016
CARLA MUBANGA	PRODUCER	17338492	YES		04/04/2016
CAROL CANFIELD	PRODUCER	17063503	YES		04/04/2016
CAROL MOORE	PRODUCER	13506614	YES		04/04/2016
CAROLYN EDWARDS	PRODUCER	585850	YES		04/04/2016
CAROLYN KELLY	PRODUCER	7993891	YES		04/04/2016
CASSARAH CHAJKOWSKI	PRODUCER	17552977	YES		04/04/2016
CATHERINE WILTSHIRE	PRODUCER	501799	YES		04/04/2016
CAYMAN DAY	PRODUCER	16285281	YES		04/04/2016
CECILIA HOUSE	PRODUCER	8933193	YES		04/04/2016
CHAD BRACKEN	PRODUCER	17055620	YES		04/04/2016

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM