Notification of Changes for Business Entity
General Information
Business Entity Name:	W&R INSURANCE AGENCY, INC.
Incorporation / Formation Date:	02/05/1985
FEIN:	43-1357226
Ohio License Number:	1143136
NPN:	15340780
DBA / Trade Name:
State of Domicile:	MO
County:	JOHNSON
Business Address
Address 1:	6300 LAMAR AVE
Address 2:
City:	SHAWNEE MISSION
State:	KS
Zip:	66202
Phone:	913-236-1326
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	6300 LAMAR AVE
Address 2:
City:	SHAWNEE MISSION
State:	KS
Zip:	66202
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
BRIAN MACHIELA	AGENT	15340780	YES		04/04/2017

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:	KRISTI JEWETT
Title:	LICENSING SERVICE REP
Phone Number:	1-800-733-3863
Email Address:	KJEWETT@WADDELL.COM