Notification of Changes for Business Entity
General Information
Business Entity Name:	WM. G. UHL AGENCY, INC.
Incorporation / Formation Date:
FEIN:	310824983
Ohio License Number:	1793
NPN:	2760186
DBA / Trade Name:
State of Domicile:	OH
County:	MONTGOMERY
Business Address
Address 1:	7755 PARAGON ROAD
Address 2:	SUITE 100
City:	DAYTON
State:	OH
Zip:	45459
Phone:	9374349090
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7755 PARAGON ROAD
Address 2:	SUITE 100
City:	DAYTON
State:	OH
Zip:	45459
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 UHL AGENCY
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:	MARC MCNULTY
Title:	V.P. OF INSURANCE OPERATIONS
Phone Number:	9374349090
Email Address:	MARCMCNULTY@UHLAGENCY.COM