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
THOMAS KNAUER	AGENT	11794544		YES	12/26/17
BOONE JACKSON	AGENT	3678725		YES	12/26/17
LUIS CORTEZ	AGENT	8485140		YES	12/26/17
JACK FRANK WESTMORELAND	AGENT	5626234		YES	12/27/17
KELLY PERRY	AGENT	3643325		YES	12/27/17
BRAD BRADY	AGENT	6595594		YES	12/27/17
BART MALCOMSON	AGENT	6509418		YES	1/3/18
MICHELLE MONSON KLISANICH	AGENT	8893266	YES		1/18/18
ROBERT O'NEILL	AGENT	17134108	YES		1/17/18
BRYAN SMITH	AGENT	341841	YES		1/17/18
NATHAN DREWS	AGENT	16289113	YES		1/12/18

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:	BOXINSURANCELIC@THRIVENT.COM