Notification of Changes for Business Entity
General Information
Business Entity Name:	GRAVIE AGENCY LLC
Incorporation / Formation Date:
FEIN:	364770470
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	10 S 5TH ST. STE. 650
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55402
Phone:	6123551590
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	10 S 5TH ST. STE. 650
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55402
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
ALBERTA MENDENHALL	MEMBER ADVISOR	2315380	YES		6/8/17
JENNY ACKERONSON	MEMBER ADVISOR	18428511	YES		6/8/17
HANNAH AARON	MEMBER ADVISOR	18429993	YES		6/8/17
GARRETT STONER	MEMBER ADVISOR	18428523	YES		6/8/17
LUKE GRABINGER	MEMBER ADVISOR	18429891	YES		6/8/17

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:	MACKENZIE BORGEN
Title:	LICENSING ANALYST
Phone Number:	6125472476
Email Address:	MBORGEN@GRAVIE.COM