Notification of Changes for Business Entity
General Information
Business Entity Name:	WELLS FARGO ADVISORS INSURANCE AGENCY LLC.
Incorporation / Formation Date:
FEIN:	540910269
Ohio License Number:	28429
NPN:
DBA / Trade Name:
State of Domicile:	VA
County:	INDEPENDENT CITY
Business Address
Address 1:	901 E BYRD ST.
Address 2:
City:	RICHMOND
State:	VA
Zip:	23219
Phone:	6057825112
Fax:	8663548566
Business Web Site Address:	WWW.WELLSFARGO.COM
Business Email Address:	MELISSA.L.SHUTT@WELLSFARGO.COM
Mailing Address
Address 1:	3201 N 4TH AVE
Address 2:
City:	SIOUX FALLS
State:	SD
Zip:	57104
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
STEPHENS, GREGORY	AGENT	1341665		YES	09/27/2016
HARDMAN, LAMARTINE	AGENT	3760697		YES	09/23/2016
SAFYURTLU, BUTCH	AGENT	8144813	YES		09/26/2016
KLEINER, ERIC	AGENT	8018026		YES	09/20/2016
RINEHART, KENNETH	AGENT	1925709		YES	09/26/2016
DEITEL, MATTHEW	AGENT	16860079		YES	09/26/2016
NEUN, SUSAN	AGENT	7942665		YES	09/19/2016
KONVES, WILLIAM	AGENT	8426494		YES	09/26/2016
HENDREN, MATTHEW	AGENT	1951795	YES		09/26/2016
FRANK, STEVEN	AGENT	547075	YES		09/27/2016
POLCAR, JEFFREY	AGENT	18117107	YES		09/27/2016
MILLAR, MARK	AGENT	510415	YES		09/22/2016
DECHIARIO, MICHAEL	AGENT	710066	YES		09/30/2016
HASHEMI, PARI	AGENT	14862086	YES		09/21/2016

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)	NO
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?	NO
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:	MELISSA L SHUTT
Title:	SOSS2
Phone Number:	6057825112
Email Address:	MELISSA.L.SHUTT@WELLSFARGO.COM