Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	41-1780150
Ohio License Number:	26090
NPN:	662734
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	OH
Zip:	55415
Phone:	920-628-3026
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
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
LUKE FICKEN	AGENT	14764856	YES		12/04/2017
WILLIAM MARSAGLIA	AGENT	2534144	YES		12/04/2017
LANCE WILEY	AGENT	4897503	YES		12/04/2017

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:	JODI GOETSCH
Title:	SR. INSURANCE LICENSING SPECIALIST
Phone Number:	920-628-3026
Email Address:	JODI.GOETSCH@THRIVENT.COM