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:	9206285808
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
TERRY HOKAJ	AGENT	7984711	YES		11/20/15
ROBERT GRIGLAK	AGENT	1281832	YES		11/20/15
AMELIA ROGERS	AGENT	17771501	YES		11/25/15
STEPHANIE BECKWITH	AGENT	16252782	YES		11/25/15
STACEE JACOBS	AGENT	10170293	YES		12/1/2015
SHANNA RENNER	AGENT	8057433	YES		12/2/2015
DAVID E ANDERSON	AGENT	17786526	YES		12/2/2015
JOHN ROMERO	AGENT	15708404	YES		12/11/2015
KNUT OLSON	AGENT	681624	YES		12/11/2015
RAMSEY ISRAWI	AGENT	9514837	YES		12/11/2015
JESSE MOSS	AGENT	17278987	YES		12/1/2015
JOHN DIETRICH	AGENT	16877691		YES	11/30/2015
MARY BETH ST JOHN	AGENT	10134921		YES	11/24/2015
CYNTHIA STEINER	AGENT	247607		YES	12/1/2015
TIM SCHMIDT	AGENT	716128		YES	12/2/2015

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:	RACHAEL STURM
Title:	COORDINATOR
Phone Number:	9206285808
Email Address:	RACHAEL.STURM@THRIVENT.COM