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
BRIAN SCHMIDT	AGENT	18369639	YES		6/12/17
TIMOTHY VALEN	AGENT	1431438	YES		6/12/17
TYLER KOSSOW	AGENT	17899070	YES		6/9/17
DANIEL JOHNSON	AGENT	18375045	YES		6/7/17
BLAKE RICHARDS	AGENT	7687324	YES		6/2/17
KENNETH WILLET	AGENT	9630289		YES	5/31/17
KEVIN KNOERNSCHILD	AGENT	2796844		YES	6/7/17
CHAD PETERSON	AGENT	995879		YES	6/9/17
RONALD KIMS	AGENT	10348918		YES	6/9/17
DEREKY KAUFMAN	AGENT	10431152		YES	6/9/17
PAUL BAKKER	AGENT	17186857		YES	6/9/17
GLENN MERTZ	AGENT	17220878		YES	6/12/17
JOAN RUIZ	AGENT	1230828		YES	6/14/17

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