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