Notification of Changes for Business Entity
General Information
Business Entity Name:	CROSS POINTE INSURANCE ADVISORS, LLC
Incorporation / Formation Date:	6/21/2010
FEIN:	272894934
Ohio License Number:	977788
NPN:	15817588
DBA / Trade Name:
State of Domicile:	AR
County:	SEBASTIAN
Business Address
Address 1:	1120 GARRISON AVENUE
Address 2:
City:	FORT SMITH
State:	AR
Zip:	72901
Phone:	4797852912
Fax:	4794244902
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1120 GARRISON AVENUE
Address 2:
City:	FORT SMITH
State:	AR
Zip:	72901
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
CHRIS STANLEY	SECRETARY	293880856	YES		5/1/2017
JOHN R. LOWTHER	TREASURER	277423254		YES	5/1/2017

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:	KRISTY STARLING
Title:	LICENSING MANAGER
Phone Number:	2547296180
Email Address:	KSTARLING@ILSAINC.COM