Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE SOLUTIONS LLC
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE 4TH FLOOR
Address 2:
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	3049293257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE $TH FLOOR
Address 2:
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
SHENECKA MURPHY	PRODUCER	189041508	YES		10/17/2016
ERIN CORBETT	PRODUCER	17875450	YES		10/17/2016
CHAUNCERY SMITH	PRODUCER	17235761	YES		10/17/2016
CHRISTOPHER MCMICHAEL	PRODUCER	17314787	YES		10/17/2016
MICHELLE BAILEY	PRODUCER	17624562	YES		10/17/2016
SERANNA WYNTER	PRODUCER	3300027	YES		10/17/2016
AIESHA COOPER	PRODUCER	17261270	YES		10/17/2016
ALISHA CROWDER	PRODUCER	17313384	YES		10/17/2016
ANGELLEN THOMPSON	PRODUCER	17038405	YES		10/17/2016
ANN MCINTOSH	PRODUCER	16229402	YES		10/17/2016
ANQUAN PATTERSON	PRODUCER	17957075	YES		10/17/2016
ARMONI NEILS	PRODUCER	18008190	YES		10/17/2016
BARRY RICHARDS	PRODUCER	7366529	YES		10/17/2016
BRITTANIE CURRY	PRODUCER	17245099	YES		10/17/2016
CRYSTAL FULLER	PRODUCER	17711469	YES		10/17/2016

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:	3049293257
Email Address:	LICENSING@TZINSURANCE.COM