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: 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: 6255 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
ISABELLA BRUNK AGENT 8261983 YES   05/31/2018
KENNETH MENEZES AGENT 18314284 YES   06/05/2018
PAUL VECCHIONE AGENT 772654 YES   06/04/2018
ANDREW MILLER AGENT 420289 YES   05/16/2018
GREG MOORE AGENT 16349878 YES   05/21/2018
MONTE SPERLING AGENT 414363   YES 05/31/2018
           
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