Notification of Changes for Business Entity
General Information
Business Entity Name:	AVANT BROKERAGE, LLC
Incorporation / Formation Date:
FEIN:	463955192
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MO
County:	JACKSON
Business Address
Address 1:	255 NW BLUE PARKWAY, SUITE 102
Address 2:
City:	LEES SUMMIT
State:	MO
Zip:	64063
Phone:	8165548162
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P.O. BOX 1540
Address 2:
City:	LEES SUMMIT
State:	MO
Zip:	64063
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
THOMAS TOLBERT	PRODUCER	556138	YES		1/17/2017

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:	THOMAS DEORIO
Title:	MEMBER/MANAGER
Phone Number:	8165548162
Email Address:	PBRENNAN@AVANTBROKERAGE.COM