Notification of Changes for Business Entity
General Information  
Business Entity Name: LINSCO PRIVATE LEDGER INSURANCE ASSOCIATES INC
Incorporation / Formation Date: 6/22/2004
FEIN: 06‐1440587
Ohio License Number: 61440587
NPN: 664043
DBA / Trade Name:  
State of Domicile: CA
County: SAN DIEGO
Business Address  
Address 1: 4707 EXECUTIVE DRIVE
Address 2:  
City: SAN DIEGO
State: CA
Zip: 92121
Phone: 800-877-7210
Fax:  
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 4707 EXECUTIVE DRIVE
Address 2:  
City: SAN DIEGO
State: CA
Zip: 92121
   
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
PFADT, WILLIAM LOUIS PRODUCER 1063682 YES   11/30/17
HUCK, MICHAEL ROY PRODUCER 1057505 YES   11/30/17
HUCK, TAYLOR ROBERT PRODUCER 1058076 YES   11/30/17
HUCK, TRAVIS M PRODUCER 1089853 YES   11/30/17
BUCK, ALAN CARL PRODUCER 1162746 YES   11/30/17
HENTZ, BRIAN JOSEPH PRODUCER 704119 YES   11/30/17
GRAUNKE, JEFFREY SCOTT PRODUCER 773285 YES   11/30/17
ROGERS, BRIAN LARRY PRODUCER 32721 YES   11/30/17
LOGAN, CHARLENE ANN PRODUCER 1027975 YES   11/30/17
SPEAKMAN, DONALD PATRICK PRODUCER 53799 YES   11/30/17
LEHMAN, MICHAEL WAYNE PRODUCER 585747 YES   11/30/17
TRIVISON, DANIEL PRODUCER 766221 YES   11/30/17
QUEEN, DAVID GREGORY PRODUCER 1111413 YES   11/30/17
WASILEWSKI, LOUIS JOSEPH PRODUCER 756979 YES   11/30/17
BOLES, GRADY WILLIAM PRODUCER 919 YES   11/30/17
           
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: JACQUELINE PARKS
Title: COMPLIANCE SPECIALIST
Phone Number: 800-877-7210
Email Address: INSURANCE.APPOINTMENTS@LPL.COM