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:	OH
County:	MANHATTAN
Business Address
Address 1:	7 HANOVER SQ
Address 2:
City:	NEW YORK
State:	NY
Zip:	10004
Phone:	6108077291
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	6244 STERNERS WAY
Address 2:
City:	BETHLEHEM
State:	PA
Zip:	18017
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
PHILIP RANDAL MASON	PRODUCER	2004354		YES	02/02/2017
RANDALL DAVEY	PRODUCER	7953417		YES	02/08/2017
PAUL ADAMS	PRODUCER	2968877		YES	12/31/2016
RONNIE MAYSE	PRODUCER	16620196		YES	09/23/2016
SCOTT JARRED	PRODUCER	7537094		YES	05/27/2016
STEPHEN KILEY	PRODUCER	1481193		YES	12/29/2016
THOMAS CATES	PRODUCER	2204782		YES	04/06/2017

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:	6108077291
Email Address:	JASON_ESKENAZI@GLIC.COM