Notification of Changes for Business Entity
General Information
Business Entity Name:	GRAVIE AGENCY LLC
Incorporation / Formation Date:
FEIN:	3604770470
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
ALAN BRYSON	ADVISOR	17705132		YES	3/27/18
AMANDA MURPHY	ADVISOR	17701180		YES	3/27/18
BRIDGET CULLEN	ADVISOR	10881138		YES	3/27/18
HANNAH TRAVIS	ADVISOR	18156862		YES	3/27/18
MEGAN TONG	ADVISOR	17418612		YES	3/27/18
AAKASH BROWN	ADVISOR	17848711	YES		3/27/18
CHANTELLE WOLFF	ADVISOR	18588804	YES		3/27/18
CHLOE SPENCER	ADVISOR	18575521	YES		3/27/18
DARIUS CLARE	ACCOUNT MANAGER	17224549	YES		3/27/18
IAN ROSS	ADVISOR	18567713	YES		3/27/18
KATE SIMONET	ACCOUNT MANAGER	18567685	YES		3/27/18
KATHLEEN MILLER	ADVISOR	6961163	YES		3/27/18
LAUREN HALE	ADVISOR	18538782	YES		3/27/18
MATTHEW VICK	ADVISOR	17224552	YES		3/27/18
PETER FAIRLEY	SALES	18043608	YES		3/27/18

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)
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:	COMPLIANCE ANALYST
Phone Number:	6125472476
Email Address:	MBORGEN@GRAVIE.COM