Notification of Changes for Business Entity
General Information
Business Entity Name:	METROPCS MICHIGAN LLC
Incorporation / Formation Date:
FEIN:	20-2509038
Ohio License Number:	996567
NPN:	17011811
DBA / Trade Name:
State of Domicile:	DE
County:	USA
Business Address
Address 1:	6200 OAK TREE BLVD, SUITE 125
Address 2:
City:	INDEPENDENCE
State:	OH
Zip:	44131
Phone:	214-570-5800
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8880 WARD PARKWAY
Address 2:
City:	KANSAS CITY
State:	MO
Zip:	64114
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	METROPCS MICHIGAN INC.
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

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:	LAKISHA DARNELL
Title:	SR LICENSING COORDINATOR
Phone Number:	816-237-3139
Email Address:	METROPCS@ASURION.COM