Notification of Changes for Business Entity
General Information
Business Entity Name:	PARK AVENUE SECURITIES
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:	81 HIGHLAND AVE
Address 2:
City:	BETHLEHEM
State:	PA
Zip:	18017
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
EILEEN BELINKIE	AGENT	80900		YES	01/10/2016
JERRY HEMMER	AGENT	7534655		YES	01/20/2016
KAREN BOYKIN	AGENT	3334074		YES	12/01/2015
SCOTT WASKIEWICZ	AGENT	17302029	YES		02/05/2016
GEOFFREY BURGESS	AGENT	2326431	YES		12/08/2015
MATTHEW GAGLIO	AGENT	1998761	YES		01/04/2016
ROBERT HARBISON	AGENT	6910054	YES		11/20/2015
JAMES LAKE	AGENT	810351	YES		01/04/2016
BRADLEY ROACH	AGENT	8978076	YES		01/08/2016
ADAM SAN JUAN	AGENT	2115020	YES		12/01/2015
DANIEL STEIGHNER	AGENT	1711845	YES		01/06/2016

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:	JASON ESKENAZI
Title:	DESIGNATED PRINCIPAL
Phone Number:	2129193058
Email Address:	JASON_ESKENAZI@GLIC.COM