Notification of Changes for Business Entity
General Information
Business Entity Name:	ASHTON AGENCY INC
Incorporation / Formation Date:
FEIN:	59-2258545
Ohio License Number:	40173
NPN:	4143660
DBA / Trade Name:
State of Domicile:	FL
County:	ORANGE
Business Address
Address 1:	4100 METRIC DR
Address 2:
City:	WINTER PARK
State:	FL
Zip:	32792
Phone:	4076785900
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 7100
Address 2:
City:	WINTER PARK
State:	FL
Zip:	32793
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
DAVID HARMS		4143660	YES		03/02/2013

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:	KATHLEEN SAFT
Title:	OPERATIONS MANANGER & FINANCIAL CONTROLLER
Phone Number:	4076781293
Email Address:	KATIESAFT@ASHTONAGENCY.COM