Notification of Changes for Business Entity
General Information
Business Entity Name:	PARK AVENUE SECURITIES LLC
Incorporation / Formation Date:
FEIN:	134023176
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NY
County:	MANHATTAN
Business Address
Address 1:	6255 STERNER'S WAY
Address 2:
City:	BETHLEHEM
State:	PA
Zip:	18017
Phone:	6108077291
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7 HANOVER SQ
Address 2:
City:	NEW YORK
State:	NY
Zip:	10004
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
ANDREW ROMANO	AGENT	11739163	YES		04/21/2017
DEREK SCHEETZ	AGENT	18160047	YES		05/11/2017
JAMAAL HENRY	AGENT	18011132	YES		05/22/2017
JONATHAN GEISER	AGENT	17033078	YES		04/16/2017
LISA ARNOLD	AGENT	17091500	YES		05/23/2017
MAXWELL MORITZ	AGENT	17288337	YES		03/15/2017
PETER ROGERS	AGENT	4622430	YES		05/04/2017
RICHARD ELLIOTT	AGENT	12859199	YES		05/02/2017
VAN EWING	AGENT	2128372	YES		05/05/2017
SHAWN ARRINGTON	AGENT	7066187	YES		03/31/2017
GEOFFREY GARDNER	AGENT	3515772		YES	06/30/2017
HENRY TERRELL	AGENT	2703149		YES	05/31/2017
MICHAEL SCERBIN	AGENT	18140237		YES	05/03/2017

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:	JASON ESKENAZI
Title:	OFFICER
Phone Number:	2129193058
Email Address:	JASON_ESKENAZI@GLIC.COM