Notification of Changes for Business Entity
General Information
Business Entity Name:	HSL LAND TITLE AGENCY
Incorporation / Formation Date:
FEIN:	27-2449926
Ohio License Number:	41332
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	7550 LUCERNE DR #206
Address 2:
City:	MIDDLEBURG HTS.
State:	OH
Zip:	44130
Phone:	3308641249
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7550 LUCERNE DR #206
Address 2:
City:	MIDDLEBURG HTS.
State:	OH
Zip:	44130
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
HOLLEY HOUGLAN	RDA AGENT	NP171087		YES	7/16/2016

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)	YES
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?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	THIS ENTITY IS AN ONGOING JOINT VENTURE/AFBA AS PREVIOUSLY DISCLOSED

Submitted By
Submitted By:	KIMBERLY MCNALLY
Title:	GENERAL COUNSEL OF MANAGING MEMBER
Phone Number:	2168984948
Email Address:	KMCNALLY@GUARDIANTITLE.COM