UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Option to purchase common stock | Â (1) | 01/28/2029 | Common Stock | 400,000 | $ 1.16 | D | Â |
Option to purchase common stock | Â (1) | 01/28/2029 | Common Stock | 200,000 | $ 2.25 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Deller Colin James C/O CLEARSIGN COMBUSTION CORPORATION 12870 INTERURBAN AVENUES SEATTLE, WA 98168 |
 |  |  President |  |
/s/ Colin James Deller | 01/31/2019 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | On January 28, 2019 the issuer and the reporting person entered into an employment agreement. As an incentive to enter into the agreement, the reporting person received the option grants reported above. The right to purchase one-third of the shares subject to the options vested on the date the reporting person entered into the employment agreement. The right to purchase the remainder of the shares will vest as follows: one-third on the first anniversary of the grant date and one-third on the second anniversary of the grant date. |