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:	6255 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
DONALD L ROSS	AGENT	713250		YES	10/13/2017
GEOFFREY L GARDNER	AGENT	3518772		YES	10/13/2017
JONATHAN HERAS	AGENT	15857272		YES	10/13/2017
LISA WIMBERG	AGENT	9253961		YES	10/13/2017
MARK SQUAIRS	AGENT	734980		YES	10/13/2017
MICHAEL SCERBIN	AGENT	18140237		YES	10/13/2017
PAUL CIAVARELL	AGENT	11728506		YES	10/13/2017
PETER MCCAY	AGENT	16484394		YES	10/13/2017
RANDALL BOLL	AGENT	16263360		YES	10/13/2017
ROBERT SLUSHER	AGENT	3209130		YES	10/13/2017
SAMUEL MATIA	AGENT	16974485		YES	10/13/2017
BUDDY CARTER	AGENT	9921922	YES		10/13/2017
GEORGE KAVALAUSKAS	AGENT	2214653	YES		10/13/2017
JONATHAN CODISPOTI	AGENT	8589436	YES		10/13/2017
JAN TRIBLER	AGENT	8766268	YES		10/13/2017

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:	JASON ESKENAZI
Title:	OFFICER
Phone Number:	2129193058
Email Address:	JASON_ESKENAZI@GLIC.COM