Notification of Changes for Business Entity
General Information  
Business Entity Name: PRITCHETT - MOORE INC
Incorporation / Formation Date: 10/01/1947
FEIN: 600262223
Ohio License Number: 1003955
NPN: 5852080
DBA / Trade Name:  
State of Domicile: OH
County: TUSCALOOSA
Business Address  
Address 1: 1120 QUEEN CITY AVE.
Address 2:  
City: TUSCALOOSA
State: AL
Zip: 35403
Phone: 2057584441
Fax: 2053496538
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: PO BOX 2086
Address 2:  
City: TUSCALOOSA
State: AL
Zip: 35403
   
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
           
Members, Owners, Partners, Officers and Directors
Name Title Identifying # Add Delete Eff. Date
THOMAS WILSON MOORE, JR. PRESIDENT 423868428 YES   05/15/2018
THOMAS WILSON MOORE, JR. DIRECTOR 423868428 YES   05/15/2018
MARLIN D. MOORE CHAIRMAN 421987115 YES   05/15/2018
MARLIN D. MOORE DIRECTOR 421987115 YES   05/15/2018
MADISON HUDSON DIRECTOR 562276043 YES   05/15/2018
THOMAS BONHAUS DIRECTOR 295801909 YES   05/15/2018
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: CHRISTY KRICK
Title: LICENSING ADMINISTRATOR
Phone Number: 8124942472
Email Address: CKRICK@SUPPORTIVEIS.COM