Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	411780150
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
Phone:	9206282569
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
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
JAMES DUFRESNE	AGENT	17360654		YES	3/8/2017
DENNIS GORSKI	AGENT	341045		YES	3/2/2017
ABILGAIL WILDER	AGENT	17604750		YES	2/21/2017
MICHAEL CALTA	AGENT	17512865		YES	2/14/2017
BEAU HOSKINS	AGENT	17960421		YES	2/14/2017
REBECCA LESTER	AGENT	638574		YES	2/7/2017
JASON CARTER	AGENT	9304281		YES	2/7/2017
GUY ELLISON	AGENT	680303		YES	2/7/2017
MOLLY ROOT	AGENT	8675233	YES		2/7/2017
MARLIN PRUISMANN	AGENT	6855142	YES		2/7/2017
KATHRYN WAISSI	AGENT	18016532	YES		2/7/2017
CHRISTOPHER SIPE	AGENT	15696286	YES		2/7/2017
VIVIA SCHIMMING	AGENT	16143159	YES		2/7/2017
TRACIE BURTON	AGENT	15463987	YES		2/10/2017
SCOTT FERGUSON	AGENT	17386802	YES		2/10/2017

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)	NO
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?	NO
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:	RACHAEL STURM
Title:	SPECIALIST
Phone Number:	9206285808
Email Address:	RACHAEL.STURM@THRIVENT.COM