0000899243-18-017221.txt : 20180619
0000899243-18-017221.hdr.sgml : 20180619
20180619183626
ACCESSION NUMBER: 0000899243-18-017221
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180124
FILED AS OF DATE: 20180619
DATE AS OF CHANGE: 20180619
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Stoner Chelsea R.
CENTRAL INDEX KEY: 0001741527
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38525
FILM NUMBER: 18908245
MAIL ADDRESS:
STREET 1: C/O AVALARA, INC.
STREET 2: 255 SOUTH KING ST., SUITE 1800
CITY: SEATTLE
STATE: WA
ZIP: 98104
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: AVALARA INC
CENTRAL INDEX KEY: 0001348036
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 911995935
STATE OF INCORPORATION: WA
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1100 2ND AVENUE
STREET 2: SUITE 300
CITY: SEATTLE
STATE: WA
ZIP: 98101
BUSINESS PHONE: (206) 641-2560
MAIL ADDRESS:
STREET 1: 1100 2ND AVENUE
STREET 2: SUITE 300
CITY: SEATTLE
STATE: WA
ZIP: 98101
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-01-24
0
0001348036
AVALARA INC
AVLR
0001741527
Stoner Chelsea R.
255 SOUTH KING ST., SUITE 1800
SEATTLE
WA
98104
1
0
0
0
Common Stock
2018-06-19
4
M
0
10000
4.50
A
10000
D
Common Stock
2018-06-19
4
F
0
1011
44.525
D
8989
D
Common Stock
2018-06-19
4
M
0
10000
9.72
A
18989
D
Common Stock
2018-06-19
4
F
0
2184
44.525
D
16805
D
Common Stock
2018-06-19
4
M
0
10000
12.20
A
26805
D
Common Stock
2018-06-19
4
F
0
2741
44.525
D
24064
D
Common Stock
2018-06-19
4
M
0
10000
12.60
A
34064
D
Common Stock
2018-06-19
4
F
0
2830
44.525
D
31234
D
Common Stock
2018-06-19
4
M
0
10000
13.84
A
41234
D
Common Stock
2018-06-19
4
F
0
3109
44.525
D
38125
D
Common Stock
2018-06-19
4
M
0
10000
16.60
A
48125
D
Common Stock
2018-06-19
4
F
0
3729
44.525
D
44396
D
Warrant (right to buy)
16.60
2018-01-24
4
A
0
10000
0.00
A
Common Stock
10000
10000
D
Warrant (right to buy)
4.50
2018-06-19
4
M
0
10000
0.00
D
Common Stock
10000
0
D
Warrant (right to buy)
9.72
2018-06-19
4
M
0
10000
0.00
D
Common Stock
10000
0
D
Warrant (right to buy)
12.20
2018-06-19
4
M
0
10000
0.00
D
Common Stock
10000
0
D
Warrant (right to buy)
12.60
2018-06-19
4
M
0
10000
0.00
D
Common Stock
10000
0
D
Warrant (right to buy)
13.84
2018-06-19
4
M
0
10000
0.00
D
Common Stock
10000
0
D
Warrant (right to buy)
16.60
2018-06-19
4
M
0
10000
0.00
D
Common Stock
10000
0
D
The shares issuable upon exercise of the warrant are subject to the terms of a lock-up agreement entered into in connection with the Issuer's initial public offering.
The warrant was fully exercisable upon grant.
Unless sooner exercised, the warrant expires immediately prior to the closing of the Issuer's initial public offering and will be automatically net exercised pursuant to its terms if not exercised prior to that time.
/s/ Daniel E. Manning, Attorney-in-Fact
2018-06-19