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
DON GEORGE	AGENT	17827706		YES	2/12/18
ANGELA KATAMPE	AGENT	3744174		YES	2/12/18
PATRICIA HENRY	AGENT	9134887		YES	2/12/18
DAVID POLZIN	AGENT	967095		YES	2/12/18
RONALD ROBINSON	AGENT	17614157		YES	2/12/18
ERIC BEADERSTADT	AGENT	8552230	YES		1/25/18
DAVID HARRINGTON	AGENT	16513726	YES		1/26/18
DUSTIN MILLER	AGENT	18564054	YES		2/2/18
TROY BIXLER	AGENT	17073046	YES		2/6/18
WILLIAM H EVANS	AGENT	17351304	YES		2/7/18
WILLIAM ANNIS	AGENT	18486730	YES		2/16/18
WILLIE SMITH	AGENT	17971686	YES		2/16/18
MICHELLE MONSON KLISANICH	AGENT	8893266	YES		2/16/18
KENDALL HEETLAND	AGENT	16681184	YES		2/16/18

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:	RACHAEL STURM
Title:	SPECIALIST
Phone Number:	9206285808
Email Address:	BOXINSURANCELIC@THRIVENT.COM