Notification of Changes for Business Entity
General Information
Business Entity Name:	ACQUISITION TITLE AGENCY INC
Incorporation / Formation Date:	01/25/1996
FEIN:	31-1455701
Ohio License Number:	69238
NPN:	1842358
DBA / Trade Name:
State of Domicile:	OH
County:	OH
Business Address
Address 1:	6 S. VERNON STREET, PO BOX 321
Address 2:
City:	SUNBURY
State:	OH
Zip:	43074
Phone:	740-965-2226
Fax:
Business Web Site Address:
Business Email Address:	KVAZQUEZ@FBYLAW.COM
Mailing Address
Address 1:	6 S. VERNON STREET, PO BOX 321
Address 2:
City:	SUNBURY
State:	OH
Zip:	43074
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
KAREN VAZQUEZ

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:	KAREN VAZQUEZ
Title:	TITLE AGENCY MANAGER
Phone Number:	740-965-2226
Email Address:	KVAZQUEZ@FBYLAW.COM