Notification of Changes for Business Entity
General Information
Business Entity Name:	DANIELS-HEAD INSURANCE AGENCY, INC.
Incorporation / Formation Date:	01/01/1998
FEIN:	742863386
Ohio License Number:	29815
NPN:
DBA / Trade Name:
State of Domicile:	TX
County:	TRAVIS
Business Address
Address 1:	1001 CAPITAL OF TEXAS HWY. S.
Address 2:	BLDG. M-100
City:	WEST LAKE HILLS
State:	TX
Zip:	78746
Phone:	800-950-0551
Fax:
Business Web Site Address:
Business Email Address:	BCG36@DHIA.COM
Mailing Address
Address 1:	POST OFFICE BOX 160730
Address 2:
City:	AUSTIN
State:	TX
Zip:	78716
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
JILL WESTBERRY	PRODUCER	1184178	YES		03/14/2018

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:	BRIDGET GARRETT
Title:	LICENSING COORDINATOR
Phone Number:	800-950-0551
Email Address:	BCG36@DHIA.COM