Notification of Changes for Business Entity
General Information
Business Entity Name:	3M1 LLC
Incorporation / Formation Date:
FEIN:	814208967
Ohio License Number:	1128326
NPN:	18173723
DBA / Trade Name:	MATHEWS FAMILY INSURANCE LLC
State of Domicile:	OH
County:	LUCAS
Business Address
Address 1:	2811 NAVARRE AVE. SUITE A
Address 2:
City:	OREGON
State:	OH
Zip:	43616
Phone:	4192626582
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2811NAVARRE AVE. SUITE A
Address 2:
City:	OREGON
State:	OH
Zip:	43616
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	MATHEWS FAMILY INSURANCEAGENCY
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:	ROBERT D. MOORE
Title:	SEC.
Phone Number:	7402250786
Email Address:	DMOORE101@COLUMBUS.RR.COM