Notification of Changes for Business Entity
General Information
Business Entity Name:	CITY SECURITIES CORP
Incorporation / Formation Date:
FEIN:	35 0230120
Ohio License Number:	24212
NPN:	957746
DBA / Trade Name:
State of Domicile:	OH
County:	MARION
Business Address
Address 1:	30 S MERIDIAN ST STE 600
Address 2:
City:	INDIANAPOLIS
State:	IN
Zip:	46204
Phone:	3176344400
Fax:	3179552532
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	30 S MERIDIAN ST STE 600
Address 2:
City:	INDIANAPOLIS
State:	IN
Zip:	46204
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
DONALD DANIELSON	DIRECTOR	203124088		YES	11/10/2015

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:	CHRISTY KRICK
Title:	LICENSING ADMINISTRATOR
Phone Number:	812494272
Email Address:	CKRICK@SUPPORTIVEIS.COM