Notification of Changes for Business Entity
General Information
Business Entity Name:	WELLS FARGO INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	41-0587845
Ohio License Number:	23765
NPN:	654461
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	550 S 4TH ST FL 10
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
Phone:	612-316-1096
Fax:	877-869-6339
Business Web Site Address:
Business Email Address:	WFIILICENSING@WELLSFARGO.COM
Mailing Address
Address 1:	550 S 4TH ST FL 10
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
DANIEL ALTMAN	AGENT	16474137		YES	02-09-2018
YAMILA ALVAREZ	AGENT	17530888		YES	02-09-2018
MATTHEW ANDERSON	AGENT	17381851		YES	02-09-2018
JASON ANGEL	AGENT	7920746		YES	02-09-2018
JOSEPH ANNEN	AGENT	15963872		YES	02-09-2018
RAY BATTLE	AGENT	1563256		YES	02-09-2018
SANDRA BLAIR	AGENT	8993420		YES	02-09-2018
DANIEL BONNESON	AGENT	567904		YES	02-09-2018
DARREN BOUTON	AGENT	16474136		YES	02-09-2018
JOHN BRODIE	AGENT	17886107		YES	02-09-2018
PHILLIP BUCK	AGENT	10652497		YES	02-09-2018
MARGARET CHRISTENSON	AGENT	10696166		YES	02-09-2018
MATTHEW COLLETTE	AGENT	16525916		YES	02-09-2018
CARLOS CORONADO	AGENT	16324923		YES	02-09-2018
SHANE CRELLY	AGENT	16194554		YES	02-09-2018

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:	AIMEE JOHNSON
Title:	LICENSING COORDINATOR
Phone Number:	612-316-1096
Email Address:	AIMEE.L.JOHNSON@WELLSFARGO.COM