SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
LANGE LOUIS G

(Last) (First) (Middle)
C/O AUDENTES THERAPEUTICS, INC.
600 CALIFORNIA STREET, 17TH FLOOR

(Street)
SAN FRANCISCO CA 94108

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/19/2016
3. Issuer Name and Ticker or Trading Symbol
Audentes Therapeutics, Inc. [ BOLD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 466,799 D
Common Stock 25,678 I By Amygdala Lange Trust(1)
Common Stock 8,558 I By Lange Minors?Trust(2)
Common Stock 73,943 I By Asset Management Ventures Fund, L.P.(3)
Common Stock 12,322 I By Camp Lowell, LLC(4)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Preferred Stock (5) (5) Common Stock 9,000 (5) D
Series B Preferred Stock (5) (5) Common Stock 13,400 (5) I By Asset Management Ventures Fund, L.P.(3)
Series B Preferred Stock (5) (5) Common Stock 2,233 (5) I By Camp Lowell, LLC(4)
Explanation of Responses:
1. The reporting person's domestic partner is the trustee of the Amygdala Lange Trust. The reporting person disclaims beneficial ownership of such securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of such securities for purposes of Section 16 or for any other purposes.
2. The reporting person's domestic partner is the trustee of the Lange Minors' Trust. The reporting person disclaims beneficial ownership of such securities, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of such securities for purposes of Section 16 or for any other purposes.
3. The reporting person is a general partner of Asset Management Ventures Fund, L.P. ("AMVF L.L.P."), and has shared voting and dispositive power over the shares held by AMVF L.L.P. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the inclusion of such securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
4. The reporting person is the president of Camp Lowell, LLC ("Camp Lowell"), and has sole voting and dispositive power over the shares held by Camp Lowell. The reporting person disclaims beneficial ownership over such securities except to the extent of his pecuniary interest therein, and the inclusion of such securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
5. Each share of the issuer's Series B Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's initial public offering and has no expiration date.
Remarks:
/s/ Thomas Soloway as attorney-in-fact for Louis Lange, M.D., Ph.D. 07/19/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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