Notification of Changes for Business Entity
General Information
Business Entity Name:	PARK AVENUE SECURITIES LLC
Incorporation / Formation Date:
FEIN:	134023176
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NY
County:	MANHATTAN
Business Address
Address 1:	7 HANOVER SQ
Address 2:
City:	NEW YORK
State:	NY
Zip:	10004
Phone:	6108077291
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	6244 STERNERS WAY
Address 2:
City:	BETHLEHEM
State:	PA
Zip:	18017
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
FAISAL SHAHED	AGENT	7477358		YES	2/1/2017
GINO GUARNIERI	AGENT	2831687		YES	11/15/2016
JAMES CONWAY	VP	4368039		YES	01/01/2017
JAMES HAILEY	AGENT	2345921		YES	10/17/2016
JAMES DRISCOLL	AGENT	5408307		YES	01/01/2017
ALLISON BURKETT-COOK	AGENT	17120237	YES		01/02/2017
AMIR NOOR	AGENT	17014626	YES		03/01/2017
DARBY MINNICK	AGENT	1056865	YES		01/24/2017
JAMES HEGLAND	AGENT	248330	YES		12/16/2016
JAMES DEMATTEO	AGENT	8787560	YES		02/16/2017
JAY WILEN	AGENT	3510794	YES		01/09/2017
M JONATHAN ADLER	AGENT	8829170	YES		02/08/2017
MARIELLE HOFFMAN	AGENT	17396889	YES		12/28/2016
MATTHEW DIRUZZA	AGENT	3678677	YES		03/10/2017
MICHAEL BEAUSAY	AGENT	2205628	YES		03/10/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MICHAEL SCERBIN	AGENT	18140237	YES		01/31/2017
THOMAS CAHILL	VP	4088561	YES		01/01/2017

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:	JASON ESKENAZI
Title:	OFFICER
Phone Number:	6108077291
Email Address:	JASON_ESKENAZI@GLIC.COM