Notification of Changes for Business Entity
General Information
Business Entity Name:	CENTRAL OHIO FINANCIAL SERVICES INC
Incorporation / Formation Date:
FEIN:	010554457
Ohio License Number:	27227
NPN:	7075049
DBA / Trade Name:
State of Domicile:	OH
County:	PIKE
Business Address
Address 1:	111 N MARKET ST
Address 2:
City:	WAVERLY
State:	OH
Zip:	45690
Phone:	7409477711
Fax:
Business Web Site Address:
Business Email Address:	BWILLIAMS@COFS.BIZ
Mailing Address
Address 1:	111 N MARKET ST
Address 2:
City:	WAVERLY
State:	OH
Zip:	45690
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
E RENEE HOWARD	AGENT	939898		YES	08/15/2017

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)	NO
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?	NO
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:	BRION C WILLIAMS
Title:	AGENT
Phone Number:	7409477711
Email Address:	BWILLIAMS@COFS.BIZ