Notification of Changes for Business Entity
General Information
Business Entity Name:	DEEP SOUTH SURPLUS, INC.
Incorporation / Formation Date:	09/20/1967
FEIN:	720900810
Ohio License Number:	39030
NPN:	3471141
DBA / Trade Name:
State of Domicile:	LA
County:	CADDO
Business Address
Address 1:	7701 LAS COLINAS RIDGE SUITE 600
Address 2:
City:	IRVING
State:	TX
Zip:	75063
Phone:	2144934228
Fax:
Business Web Site Address:
Business Email Address:	AGENCYLICENSING@DEEP-SOUTH.COM
Mailing Address
Address 1:	7701 LAS COLINAS RIDGE SUITE 600
Address 2:
City:	IRVING
State:	TX
Zip:	75063
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
JAMES HUGHES	VP, DRLP	8001512		YES	8/18/16
MICHELLE LOWRY	VP, DRLP	13101048	YES		8/18/16

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:	TRACY BOWDEN
Title:	PRESIDENT
Phone Number:	214-493-4228
Email Address:	AGENCYLICENSING@DEEP-SOUTH.COM