Notification of Changes for Business Entity
General Information
Business Entity Name:	ACSIA PARTNERS, LLC
Incorporation / Formation Date:	05/17/2012
FEIN:	90-0847289
Ohio License Number:	978388
NPN:
DBA / Trade Name:
State of Domicile:	WA
County:	KINGS
Business Address
Address 1:	5110 CARILLON POINT
Address 2:
City:	KIRKLAND
State:	WA
Zip:	98033
Phone:	800-362-8837
Fax:
Business Web Site Address:
Business Email Address:	ALISON@INSCOMPLY.COM
Mailing Address
Address 1:	5110 CARILLON POINT
Address 2:
City:	KIRKLAND
State:	WA
Zip:	98033
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
KEN DEHN	RDA	808867		YES	06/19/18

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:	ALISON KLEIN
Title:	LICENSING SPECIALIST
Phone Number:	9123537013
Email Address:	ALISON@INSCOMPLY.COM