0001144204-17-004041.txt : 20170126
0001144204-17-004041.hdr.sgml : 20170126
20170126163351
ACCESSION NUMBER: 0001144204-17-004041
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170125
FILED AS OF DATE: 20170126
DATE AS OF CHANGE: 20170126
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CLEARSIGN COMBUSTION CORP
CENTRAL INDEX KEY: 0001434524
STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823]
IRS NUMBER: 000000000
STATE OF INCORPORATION: WA
BUSINESS ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
BUSINESS PHONE: (206) 673-4848
MAIL ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ruiz Roberto
CENTRAL INDEX KEY: 0001563443
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35521
FILM NUMBER: 17550183
MAIL ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
4
1
v457574_4.xml
OWNERSHIP DOCUMENT
X0306
4
2017-01-25
0
0001434524
CLEARSIGN COMBUSTION CORP
CLIR
0001563443
Ruiz Roberto
12870 INTERURBAN AVENUE SOUTH
SEATTLE
WA
98168
0
1
0
0
Chief Operating Officer
Common Stock/CLIR
2017-01-25
4
X
0
1080
4.00
A
6480
D
Common Stock/CLIR
2017-01-25
4
X
0
760
4.00
A
4560
I
By IRA
Subscription Rights (Right to Purchase)
4.00
2016-12-27
4
X
0
1080
0
D
2016-12-27
2017-01-13
See Footnote
1080
0
D
Subscription Rights (Right to Purchase)
4.00
2016-12-27
4
X
0
760
0
D
2016-12-27
2017-01-13
See Footnote
760
0
I
By IRA
Warrant to Purchase Common Stock
4.00
2017-01-25
4
X
0
1080
A
2017-01-25
2019-01-25
Common Stock
1080
1080
D
Warrant to Purchase Common Stock
4.00
2017-01-25
4
X
0
760
A
2017-01-25
2019-01-25
Common Stock
760
760
I
By IRA
The common stock and the warrants reported on this Form 4 were acquired pursuant to the exercise of subscription rights previously distributed by the Issuer to all holders of the Issuer's common stock. Each holder received 0.2 subscription rights per share of stock owned, and each right allowed the recipient to purchase one unit, consisting of one share of common stock and one warrant to purchase one share of common stock. The subscription price per unit was $4.00.
Each warrant entitles the holder to purchase one share of the Company's common stock at an exercise price of $4.00 from the date of issuance through January 25, 2019.
/s/ Roberto Ruiz
2017-01-26