Notification of Changes for Business Entity
General Information
Business Entity Name:	TIM CRAWFORD INSURANCE AGENCY, INC.
Incorporation / Formation Date:
FEIN:	38-3666017
Ohio License Number:	949545
NPN:	8291022
DBA / Trade Name:
State of Domicile:	MI
County:	OAKLAND
Business Address
Address 1:	1415 WALTON BLVD.
Address 2:
City:	ROCHESTER HILLS
State:	MI
Zip:	48309
Phone:	248-402-5005
Fax:	248-652-4420
Business Web Site Address:
Business Email Address:	CRAWFOT@NATIONWIDE.COM
Mailing Address
Address 1:	1415 WALTON BLVD.
Address 2:
City:	ROCHESTER HILLS
State:	MI
Zip:	48309
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	THE CRAWFORD INSURANCE GROUP
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

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)	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:	TIM CRAWFORD
Title:	PRESIDENT
Phone Number:	248-402-5005
Email Address:	PICMAND@NATIONWIDE.COM