Notification of Changes for Business Entity
General Information
Business Entity Name:	ROACH HOWARD SMITH & BARTON INC
Incorporation / Formation Date:
FEIN:	75-2760506
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	TX
County:	DALLAS
Business Address
Address 1:	8750 N CENTRAL EXPWY STE 500
Address 2:
City:	DALLAS
State:	TX
Zip:	75231
Phone:	972-744-2702
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8750 N CENTRAL EXPWY STE 500
Address 2:
City:	DALLAS
State:	TX
Zip:	75231
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
BRUCE BENJAMIN BRIGGS	VICE PRESIDENT	513-96-2137		YES	03/10/2016
GWEN BIEHLER	OWNER	453-86-7826		YES	03/10/2016
KAREN K FARRIS	OWNER	300-44-3369		YES	03/10/2016
LEIGH C HARRIS	VICE PRESIDENT	256-51-8733		YES	03/10/2016
PAULA J WALTERS	VICE PRESIDENT	453-88-9172		YES	03/10/2016
RYAN CARTWRIGHT HYMAN	VICE PRESIDENT	247-43-7325		YES	03/10/2016
BARTON HAYES TUCKER	PRESIDENT	459-13-1819		YES	03/10/2016
THOMAS ALLEN HUGHSTON	VICE PRESIDENT	460-47-8355		YES	03/10/2016

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:	KELLY POTTS
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-494-2395
Email Address:	KDPOTTS@SUPPORTIVEIS.COM