Notification of Changes for Business Entity
General Information
Business Entity Name:	SANDERS INSURANCE SERVICE INC.
Incorporation / Formation Date:
FEIN:	341889953
Ohio License Number:	23827
NPN:	3243855
DBA / Trade Name:
State of Domicile:	OH
County:	ASHLAND
Business Address
Address 1:	1329 US 42 SOUTH
Address 2:
City:	ASHLAND
State:	OH
Zip:	44805
Phone:	4196510796
Fax:
Business Web Site Address:	WWW.SANDERSINSURANCESERVICES.BIZ
Business Email Address:	THOMAS@SANDERSINSURANCESERVICES.BIZ
Mailing Address
Address 1:	P.O. BOX 957
Address 2:
City:	ASHLAND
State:	OH
Zip:	44805
Indicate the type of change you are seeking
Address Change:	YES
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
THOMAS SANDERS	PRESIDIENT	1775011

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
THOMAS SANDERS

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:	THOMAS R. SANDERS
Title:	PRESIDENT
Phone Number:	4196510796
Email Address:	THOMAS@SANDERSINSURANCESERVICES.BIZ