Notification of Changes for Business Entity
General Information
Business Entity Name:	WELLS FARGO ADVISORS INSURANCE AGENCY LLC.
Incorporation / Formation Date:
FEIN:	540910269
Ohio License Number:	28429
NPN:
DBA / Trade Name:
State of Domicile:	VA
County:	INDEPENDENT CITY
Business Address
Address 1:	901 E BYRD ST.
Address 2:
City:	RICHMOND
State:	VA
Zip:	23219
Phone:	6057825112
Fax:	8448790217
Business Web Site Address:	WWW.WELLSFARGO.COM
Business Email Address:	AGENCYLICENSING@WELLSFARGO.COM
Mailing Address
Address 1:	3201 N 4TH AVE
Address 2:
City:	SIOUX FALLS
State:	SD
Zip:	57104
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
KRISTOF, JACK A	AGENT	2164762		YES	06/02/2017
STORDAHL, WILLIAM J	AGENT	666671		YES	06/02/2017
ANTONELLI, BERNICE J	AGENT	11759462		YES	06/02/2017
ALEXANDER, PHILLIP MICHAEL	AGENT	16274802	YES		06/01/2017
COYNE, KEVIN J	AGENT	2037952		YES	06/02/2017
MCEACHERN, MARY N	AGENT	2487193		YES	06/02/2017
ASHNER, LEON D	AGENT	3295072	YES		05/30/2017
TOSE, LORI ANN	AGENT	3308084	YES		05/30/2017
MCCLOY, KELLY M	AGENT	3515689		YES	06/01/2017
SELIGMAN, MARCUS BROWN	AGENT	6756118	YES		06/02/2017
DEDMON JR, JIM C	AGENT	7331696		YES	06/02/2017
VARGO JR, JAMES X	AGENT	7483200		YES	06/02/2017
FOSTER, MARK L	AGENT	752839		YES	06/02/2017
MATOLA, JORDAN J	AGENT	8419051	YES		05/30/2017
CROTHERS, CHRISTOPHER	AGENT	8772118	YES		05/30/2017

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)	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:	MELISSA L SHUTT
Title:	SOSS2
Phone Number:	6057825112
Email Address:	MELISSA.L.SHUTT@WELLSFARGO.COM