Notification of Changes for Business Entity
General Information
Business Entity Name:	SHANE AND SHANE LLC
Incorporation / Formation Date:	03/03/2015
FEIN:	47-3295603
Ohio License Number:	1059319
NPN:
DBA / Trade Name:	SHANE AND SHANE FINANCIAL
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	6179 MEMORIAL DRIVE
Address 2:
City:	DUBLIN
State:	OH
Zip:	43017
Phone:	614-659-7639
Fax:
Business Web Site Address:	WWW.SHANEANDSHANEFINANCIAL.COM
Business Email Address:
Mailing Address
Address 1:	6179 MEMORIAL DRIVE
Address 2:
City:	DUBLIN
State:	OH
Zip:	43017
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

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:	SHANE EIGHME
Title:	PARTNER
Phone Number:	614-659-7639
Email Address:	SHANEE@SHANEANDSHANEFINANCIAL.COM