Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY
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:	920-628-5808
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
DAVID HURST	AGENT	7170101	YES		12/15/17
LESLIE L SMITH	AGENT	6506952	YES		12/11/17
RUSSELL ST JOHN	AGENT	18562746	YES		12/11/17
MATTHEW TILLACK	AGENT	18624715	YES		12/8/17
MARK FONTANA	AGENT	425601	YES		12/4/17
SARAH AUERNHAMMER	AGENT	540302	YES		11/29/17
BRIAN CLEMONS	AGENT	17330520	YES		11/28/17
RUSSELL AUYEUNG	AGENT	7330790	YES		11/20/17
DANIEL MITCHELL	AGENT	8989437		YES	12/18/17
LORI PLEMENS	AGENT	18470493		YES	12/4/17
JEFFREY SOLOMONSON	AGENT	1948197		YES	12/4/17
TODD LUCIUS	AGENT	16384921		YES	11/29/17
WILLIAM WYKOFF	AGENT	16635914		YES	11/27/17

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)	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