Notification of Changes for Business Entity
General Information
Business Entity Name:	MML INSURANCE AGENCY, LLC
Incorporation / Formation Date:
FEIN:	04-3109325
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MA
County:	HAMPDEN
Business Address
Address 1:	1295 STATE STREET
Address 2:
City:	SPRINGFIELD
State:	MA
Zip:	01111
Phone:	800-767-1000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1295 STATE STREET
Address 2:
City:	SPRINGFIELD
State:	MA
Zip:	01111
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
JOHN IRVING	PRODUCER	2011011	YES		5/24/2017
CASEY BURKHEAD	PRODUCER	15309074		YES	5/24/2017
STEVEN KENSKI	PRODUCER	2045948		YES	5/5/2017
SCOTT DUBIN	PRODUCER	3974220	YES		5/16/2017
RICHARD WURST	PRODUCER	18257762	YES		5/11/2017

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:	JOHN ROGAN
Title:	AVP
Phone Number:	800-767-1000
Email Address:	JROGAN@MASSMUTUAL.COM