Notification of Changes for Business Entity
General Information
Business Entity Name:	PARK AVENUE SECURITIES LLC
Incorporation / Formation Date:
FEIN:	134023176
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NY
County:	MANHATTAN
Business Address
Address 1:	7 HANOVER SQ
Address 2:
City:	NEW YORK
State:	NY
Zip:	10004
Phone:	6108077291
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7 HANOVER SQ
Address 2:
City:	NEW YORK
State:	NY
Zip:	10004
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
ROSENTHAL, LAWRENCE	AGENT	3748131	YES		08/28/2015
GHAHREMANI, ASHKAN	AGENT	8876176	YES		08/31/2015
PUTTROFF, AARON	AGENT	9233390	YES		08/07/2015
JARRED, SCOTT	AGENT	7537094	YES		09/01/2015
MULLANEY, DANIEL	AGENT	8780344	YES		08/04/2015
INMAN, WILLIAM	AGENT	7949786	YES		07/01/2015
MCGINLEY, ERIC	AGENT	15823197	YES		08/04/2015
YOUREE, CHARLES	AGENT	2795960	YES		10/20/2015
BEEBE, DOUGLAS	AGENT	17235913	YES		10/05/2015
CODISPOTI, JONATHAN	AGENT	8589436	YES		08/28/2015
KNEZEVICH, EDWARD	AGENT	17075044	YES		10/09/2015
BURGER, RICK	AGENT	16463963	YES		07/22/2015
BOLL, RANDALL	AGENT	16263360	YES		09/30/2015
KIDWELL, KELLY	AGENT	1346593	YES		08/26/2015
SHAHED, FAISAL	AGENT	7477358	YES		07/29/2015

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
CIAVARELLA, PAUL	AGENT	11728506	YES		10/15/2015
BERARD, RAYMOND	AGENT	1584163	YES		09/02/2015
DERR, CARLA	AGENT	6079778		YES	11/10/2015
NYCKLEMOE, DANIEL	AGENT	7553995		YES	10/31/2015
STERN, DAVID	AGENT	15520932		YES	09/03/2015
BLUMENCRANZ, ERIC	AGENT	365313		YES	10/22/2015
MACK, JOHN	AGENT	732606		YES	08/24/2015
JOHNSON, KIMBERLY	AGENT	2757357		YES	07/01/2015
DIETZ, LARRY	AGENT	326389		YES	11/2/2015
KASTER, LYNN	AGENT	12794778		YES	07/31/2015

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:	MARY SINKIEWICZ
Title:	SUPERVISOR
Phone Number:	6108077291
Email Address:	MARY_SINKIEWICZ@GLIC.COM