Notification of Changes for Business Entity
General Information
Business Entity Name:	LINSCO PRIVATE LEDGER INSURANCE ASSOCIATES INC
Incorporation / Formation Date:	6/22/2004
FEIN:	06‐1440587
Ohio License Number:	61440587
NPN:	664043
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	4707 EXECUTIVE DRIVE
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92121
Phone:	18008777210
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4707 EXECUTIVE DRIVE
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92121
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
KOLLMORGEN, KEVIN RONALD	PRODUCER	1098012	YES		11/30/17
BLATT, HOWARD JOSEPH	PRODUCER	69525	YES		11/30/17
NICOLET, MARK ALAN	PRODUCER	1024077	YES		11/30/17

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:	JACQUELINE PARKS
Title:	COMPLIANCE SPECIALIST
Phone Number:	800-877-7210
Email Address:	JACQUELINE.PARKS@LPL.COM