Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	41-1780150
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
Phone:	920-628-3136
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	625 FOURTH ST 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
BRAINARD SIMPSON	AGENT	17729114	YES		6/3/2016
MATTHEW TAYLOR	AGENT	16878597	YES		6/3/2016
STEVEN SCHMITT	AGENT	8394800	YES		5/27/2016
EVAN LONGSTRETH	AGENT	4587132	YES		5/19/2016
ROBERT SEDA	AGENT	17604638	YES		5/20/2016
JASON GENA	AGENT	17796365	YES		5/20/2016
JONATHAN WILTERDINK	AGENT	17827698	YES		5/19/2016
DONALD SKETCHLEY	AGENT	8616855		YES	5/31/2016

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:	ROBIN MILNER
Title:	SR ADMINISTRATIVE ASSISTANT
Phone Number:	920-628-3175
Email Address:	ROBIN.MILNER@THRIVENT.COM