Notification of Changes for Business Entity
General Information
Business Entity Name:	HUNTER INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	341132989
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	MEDINA
Business Address
Address 1:	703 N COURT ST
Address 2:
City:	MEDINA
State:	OH
Zip:	44256`
Phone:	330-725-4543
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 446
Address 2:
City:	M
State:	OH
Zip:	44258
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
JOYCE HILLRICH	LICENSED PRODUCER	1862548	YES		12-6-2017

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:	DANIEL W HUNTER
Title:	PRESIDENT
Phone Number:	330-725-4543
Email Address:	DANHUNTER@HUNTERINS.COM