Notification of Changes for Business Entity
General Information
Business Entity Name:	PURSHE KAPLAN STERLING INVESTMENTS
Incorporation / Formation Date:
FEIN:	13-3749682
Ohio License Number:	29583
NPN:	69055811
DBA / Trade Name:
State of Domicile:	NY
County:	ALBANY
Business Address
Address 1:	18 CORPORATE WOODS BLVD
Address 2:
City:	ALBANY
State:	NY
Zip:	12211
Phone:	5184363536
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	18 CORPORATE WOODS BLVD
Address 2:
City:	ALBANY
State:	NY
Zip:	12211
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
ROBERT MOORE	REGISTERED REPRESENTATIVE	7384156	YES		10/10/16

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:	REBECCA VAN NORSTRAND
Title:	LICENSING COORDINATOR
Phone Number:	518-436-3536
Email Address:	RVANNORSTRAND@PKSINVEST.COM