Notification of Changes for Business Entity
General Information
Business Entity Name:	PARKER STEVENS AGENCY, LLC
Incorporation / Formation Date:
FEIN:	39-2041981
Ohio License Number:	28219
NPN:	7343748
DBA / Trade Name:
State of Domicile:	WI
County:	PORTAGE
Business Address
Address 1:	1800 NORTH POINT DR
Address 2:
City:	STEVENS POINT
State:	WI
Zip:	54481
Phone:	800-248-4087
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1800 NORTH POINT DR
Address 2:
City:	STEVENS POINT
State:	WI
Zip:	54481
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
JOSE GONZALEZ	DIRECT SALES SUPERVISOR	17751269	YES		08/30/18
VANESSA ELBA RAMIREZ	DIRECT SALES REP	18387955	YES		08/30/18
SHONA RUSSELL STRUTHERS	DIRECT SALES REP	6727618	YES		08/30/18
JESUS ALBERTO ARVIZU RAMIREZ	DIRECT SALES REP	18483740	YES		08/30/18
STEPHEN J BAKER	DIRECT SALES REP	3430562	YES		08/30/18
JOAQUIN DURAZO CORDOVA	DIRECT SALES REP	18759956	YES		08/30/18
VANESSA ELIZARRARAS	DIRECT SALES REP	17319419	YES		08/30/18
MICHAEL LYNN GALLAGHER	DIRECT SALES REP	2725423	YES		08/30/18
MARTIN GAMEZ	DIRECT SALES REP	18483712	YES		08/30/18
TIFFANY M GRANT	DIRECT SALES REP	16603026	YES		08/30/18
TAYLOR HINTZ	DIRECT SALES REP	18489042	YES		08/30/18
FREDDY HUNT	DIRECT SALES REP	18493587	YES		08/30/18
SHELLY SANAE JASPER	DIRECT SALES REP	15045825	YES		08/30/18
CINDY TOUCH JEFFRIES	DIRECT SALES REP	2642481	YES		08/30/18
SAVANA LACROSSE	DIRECT SALES REP	18532450	YES		08/30/18

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:	NANCY PETRUSKA
Title:	SUPPORT SUPERVISOR
Phone Number:	715-346-7383
Email Address:	NANCY.PETRUSKA@SENTRY.COM