0001209191-21-000173.txt : 20210104 0001209191-21-000173.hdr.sgml : 20210104 20210104144636 ACCESSION NUMBER: 0001209191-21-000173 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201222 FILED AS OF DATE: 20210104 DATE AS OF CHANGE: 20210104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dixon Adiya CENTRAL INDEX KEY: 0001838731 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36104 FILM NUMBER: 21501369 MAIL ADDRESS: STREET 1: 111 N CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: POTBELLY CORP CENTRAL INDEX KEY: 0001195734 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 364466837 FISCAL YEAR END: 1230 BUSINESS ADDRESS: STREET 1: 111 N. CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 BUSINESS PHONE: 3129510600 MAIL ADDRESS: STREET 1: 111 N. CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-12-22 1 0001195734 POTBELLY CORP PBPB 0001838731 Dixon Adiya 111 N CANAL SUITE 850 CHICAGO IL 60606 0 1 0 0 SVP, CLO and Secretary /s/ Adiya Dixon 2021-01-04