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
ALEX LINDER	AGENT	8268462		YES	04/29/2016
RICAHRD WOLF	AGENT	292718		YES	04/29/2016
GREGG WALTHER	AGENT	2163965		YES	04/21/2016
DOMINIC RUSSO	AGENT	1759545	YES		4/21/16
ELENA BECKIUS	AGENT	8273831	YES		4/22/16
DANIELLE LARISON	AGENT	16152105	YES		4/27/16
ASHLEY DECKER	AGENT	17079427	YES		4/28/16
STEVEN ERICKSON	AGENT	320070	YES		5/4/16
KEITH DREGER	AGENT	300924	YES		5/4/16
AARON WILKS	AGENT	15672763	YES		5/6/16
JEFFERY VIETH	AGENT	17286346	YES		5/6/16
BRYAN KNOP	AGENT	8052452	YES		5/13/16
EVAN LONGSTRETH	AGENT	4587132	YES		5/16/16

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