Notification of Changes for Business Entity
General Information
Business Entity Name:	METZGER INSURANCE AGENCY LLC
Incorporation / Formation Date:
FEIN:	205605143
Ohio License Number:	35215
NPN:	8936119
DBA / Trade Name:
State of Domicile:	OH
County:	PICKAWAY
Business Address
Address 1:	404 MILL ST
Address 2:
City:	WILLIAMSPORT
State:	OH
Zip:	43164
Phone:	7409864871
Fax:	7409869324
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P O BOX 158
Address 2:
City:	WILLIAMSPORT
State:	OH
Zip:	43164
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
CHANCE SOWERS	PRODUCER	18357209	YES		1/3/18
CRYSTAL SOWERS	EMPLOYEE	2772275		YES	1/3/18
MALLORY BREINER	PRODUCER	16911482	YES		1/3/18

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
CRYSTAL SOWERS	OWNER	2772275	YES		1/3/18

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:	CRYSTAL SOWERS
Title:	OWNER
Phone Number:	740-986-4871
Email Address:	CLSOWERS@FRONTIER.COM