Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY IN
Incorporation / Formation Date:
FEIN:	41-1780150
Ohio License Number:	26090
NPN:	662734
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:	620-682-3026
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
CASEY WALKER	AGENT	9145242	YES		10/17/2017
MATTHEW SCHWARZ	AGENT	18552472	YES		10/17/2017
ROY MASON	AGENT	1958570	YES		10/17/2017
GREG LOVETTE	AGENT	10911313	YES		10/23/2017
CRAIG NENNIG	AGENT	18406485	YES		10/24/2017
SHAWN BLOBAUM	AGENT	12382790	YES		10/24/2017
SARA NEWBURN	AGENT	17903228	YES		10/26/2017
PATRICK SHANAHAN	AGENT	18368478	YES		10/31/207
MARK PIERCE	AGENT	359267	YES		11/2/2017
TODD TRAUTMANN	AGENT	2196923	YES		11/7/2017
SUSAN SMITH	AGENT	6445285	YES		11/7/2017
DEBORAH PIERCE	AGENT	3691721	YES		11/7/2017
CHRISTOPHER GIBBONS	AGENT	9406473		YES	10/17/2017
KEVIN PENTZ	AGENT	11742919		YES	10/23/2017
BIANCA MARCELLINO	AGENT	17978947		YES	10/30/2017

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:	JODI GOETSCH
Title:	SR INSURANCE LICENSING SPECIALIST
Phone Number:	920-628-3026
Email Address:	JODI.GOETSCH@THRIVENT.COM