Notification of Changes for Business Entity
General Information
Business Entity Name:	ASCENDANT TITLE, INC.
Incorporation / Formation Date:
FEIN:	20-0677858
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CO
County:	JEFFERSON
Business Address
Address 1:	215 UNION BLVD., SUITE 315
Address 2:
City:	LAKEWOOD
State:	CO
Zip:	80228
Phone:	303-800-5291
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	215 UNION BLVD., SUITE 315
Address 2:
City:	LAKEWOOD
State:	OH
Zip:	80288
Indicate the type of change you are seeking
Address Change:	YES
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

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:	LAWLESS BARRIENTOS
Title:	VICE PRESIDENT
Phone Number:	303-800-5291
Email Address:	LAWLESS@ATCOLORADO.COM