Notification of Changes for Business Entity
General Information
Business Entity Name:	LINSCO PRIVATE LEDGER INSURANCE ASSOCIATES INC
Incorporation / Formation Date:	6/22/2004
FEIN:	06‐1440587
Ohio License Number:	61440587
NPN:	664043
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	4707 EXECUTIVE DRIVE
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92121
Phone:	800-877-7210
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4707 EXECUTIVE DRIVE
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	29715
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
KRAHE, THOMAS MICHAEL	PRODUCER	623689	YES		11/30/17
ROSTONI, LENORE JOAN		1141746	YES
HUMMEL, PAUL DUANE		1095781	YES
ALBITZ, BETTY JEAN		241353	YES
DISLER, CHRISTOPHER K		590983	YES
THOMAS, DIXIE LEE		828168	YES
BARNES, JODIE LYNN		1128874	YES
HULL, MARK HAROLD		840778	YES
STODDARD, KEVIN ELWOOD		789082	YES
KEEGAN, EARL ROBERT		1145264	YES
KEMP, MARK DAVID		1008877	YES
LINTON, KYLE RUSSELL		536648	YES
LANDIS, ERIC LEE		709197	YES
SNYDER, JILLIAN RAE HOMYAK		1000392	YES
GRIDER, ANDREW RIBELIN		1055162	YES

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

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