Notification of Changes for Business Entity
General Information
Business Entity Name:	DEERFIELD AG SERVICES, INC
Incorporation / Formation Date:	06/20/2017
FEIN:	34-1283310
Ohio License Number:	39600
NPN:	13969544
DBA / Trade Name:
State of Domicile:	OH
County:	PORTAGE
Business Address
Address 1:	9041 ST RT 224
Address 2:	P.O BOX 155
City:	DEERFIELD
State:	OH
Zip:	44411
Phone:	330-584-4715
Fax:	330-584-6420
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	9041 ST RT 224
Address 2:	P.O.BOX 155
City:	DEERFIELD
State:	OH
Zip:	44411
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	DEERFIELD FARMS SERVICE, INC
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)
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:	BOYD W WALLBROWN
Title:	PRESIDENT
Phone Number:	330-584-4715
Email Address:	BILLWALL@DEERFIELDFARMS.COM