Notification of Changes for Business Entity
General Information
Business Entity Name:	THE CITIZENS BANK COMPANY
Incorporation / Formation Date:	05/28/1994
FEIN:	31-4148090
Ohio License Number:
NPN:	8853514
DBA / Trade Name:
State of Domicile:	OH
County:	WASHINGTON
Business Address
Address 1:	501 FIFTH ST.
Address 2:	P.O. BOX 128
City:	BEVERLY
State:	OH
Zip:	45715
Phone:	740-984-2381
Fax:	740-984-2386
Business Web Site Address:	WWW.THECITIZENS.COM
Business Email Address:
Mailing Address
Address 1:	501 FIFTH ST.
Address 2:	P.O. BOX 128
City:	BEVERLY
State:	OH
Zip:	45715
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
LOIS J MORRIS	VICE PRESIDENT	8827628		YES	04/30/2017

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)
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:	LISA J KEENEY
Title:	COMPLIANCE/BSA OFFICER
Phone Number:	740-984-2381
Email Address:	LKEENEY@THECITIZENS.COM