Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	411780150
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:	9206285808
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	625 FOURTH 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
ROBERT PETRI	AGENT	17691720	YES		11/13/15
WILLIAM POWERS	AGENT	4632982	YES		11/9/15
JEREMY ASHLEY	AGENT	17287621	YES		10/29/15
DEBORAH PELLEGRENE	AGENT	7615862	YES		10/29/15
DREW CONSTANZER	AGENT	16410798	YES		10/26/15
RICHARD BAAS	AGENT	15417793	YES		10/21/15
JULIE NOBILE	AGENT	8282645		YES	11/13/15
DAVID SABELLA	AGENT	16998804		YES	11/13/15
BRIAN PALM	AGENT	14970445		YES	11/9/15
JASON BURLEY	AGENT	12120279		YES	10/30/15
RICHARD DREWS	AGENT	360801		YES	10/26/15
JAMES FRIGSTAD	AGENT	8202581		YES	10/26/15
JONATHAN HAUGEN	AGENT	5740457		YES	10/26/15
MAX LAMBDIN	AGENT	8036233		YES	10/26/15
NICHOLAS WIEDRICH	AGENT	11161710		YES	10/26/15

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:	RACHAEL STURM
Title:	COORDINATOR
Phone Number:	9206285808
Email Address:	RACHAEL.STURM@THRIVENT.COM