Notification of Changes for Business Entity
General Information
Business Entity Name:	FUTURITY FIRST INSURANCE GROUP INC.
Incorporation / Formation Date:	01/04/2008
FEIN:	26-1557385
Ohio License Number:	37860
NPN:	10348037
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	101 CENTERPOINT DR STE 208
Address 2:
City:	MIDDLETOWN
State:	CT
Zip:	06457
Phone:	402-343-3634
Fax:
Business Web Site Address:
Business Email Address:	CYNTHIA@SENIORMARKETSALES.COM
Mailing Address
Address 1:	8420 W DODGE RD STE 510
Address 2:
City:	OMAHA
State:	NE
Zip:	68114
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
MICHAEL LEO CAPUTO	PRODUCER	6726774		YES	12/07/2017
ORLANDO CRUZ	PRODUCER	9197543		YES	12/07/2017
VICTOR VARELA	PRODUCER	18098666		YES	12/07/2017
ANITA JUNE BOYCE	PRODUCER	18067504		YES	12/07/2017
BRADLEY RYAN GUSLER	PRODUCER	14748995		YES	12/07/2017
LILIANA M DEL VALLE	PRODUCER	9724330		YES	12/07/2017
JEFFREY SELAN	PRODUCER	12353450		YES	12/07/2017
CAMI HALL	PRODUCER	17592805		YES	12/07/2017
RASHARD M POINDEXTER	PRODUCER	81707612		YES	12/07/2017
JOE VICTOR FLORES	PRODUCER	4590773		YES	12/07/2017
DANIEL JAMES COPELAND JR	PRODUCER	8704129	YES		12/07/2017
ISAAC ANTHONY DE LA CRUZ	PRODUCER	18498653	YES		12/07/2017
DANA C HANNAH	PRODUCER	8450374	YES		12/07/2017

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:	HERSHEL KLEINBERG
Title:	CEO
Phone Number:	402-343-3634
Email Address:	CYNTHIA@SENIORMARKETSALES.COM