Notification of Changes for Business Entity
General Information
Business Entity Name:	WELLS FARGO INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	410587845
Ohio License Number:	23765
NPN:	654461
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	550 S 4TH ST
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
Phone:	612.667.3931
Fax:
Business Web Site Address:
Business Email Address:	WFIILICENSING@WELLSFARGO.COM
Mailing Address
Address 1:	550 S 4TH ST
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55418
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
MICHAEL RIGGS	PRODUCER	16972147		YES	02/08/2018
MARIO RODRIGUEZ	PRODUCER	16250128		YES	02/08/2018
MICHAEL ROEDER	PRODUCER	15775807		YES	02/08/2018
SYLVIA RUIZ	PRODUCER	16434563		YES	02/08/2018
MICHAEL SCHMITZ	PRODUCER	16972153		YES	02/08/2018
KAREN SEGURA	PRODUCER	8701809		YES	02/08/2018
VERNON SHEPPARD	PRODUCER	17685637		YES	02/08/2018
JOSE SOBERANES	PRODUCER	17769716		YES	02/08/2018
ANTHONY STEELE	PRODUCER	9682716		YES	02/08/2018
BRANDON STRUCK	PRODUCER	8726156		YES	02/08/2018
SCOTT TAYLOR	PRODUCER	15647514		YES	02/08/2018
PAUL THOMPSON	PRODUCER	7705532		YES	02/08/2018
FRANCIS TORRES	PRODUCER	7336261		YES	02/08/2018
MICHAEL TURNER	PRODUCER	17769628		YES	02/08/2018
DANIEL TYRRELL	PRODUCER	10348849		YES	02/08/2018

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:	SHARMAINE ECKARD
Title:	LICENSING COORDINATOR
Phone Number:	612.667.3931
Email Address:	SHARMAINE.ECKARD@WELLSFARGO.COM