0001144204-17-028043.txt : 20170516 0001144204-17-028043.hdr.sgml : 20170516 20170516202434 ACCESSION NUMBER: 0001144204-17-028043 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170511 FILED AS OF DATE: 20170516 DATE AS OF CHANGE: 20170516 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: Fike Brian Grant CENTRAL INDEX KEY: 0001706465 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 17850101 MAIL ADDRESS: STREET 1: 12755 SE 73RD PLACE CITY: NEWCASTLE STATE: WA ZIP: 98056-1315 3 1 v467197_3.xml OWNERSHIP DOCUMENT X0206 3 2017-05-11 0 0001434524 CLEARSIGN COMBUSTION CORP CLIR 0001706465 Fike Brian Grant 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 0 1 0 0 Interim CFO Option to Purchase Common Stock 4.21 2026-03-31 Common Stock 5000 D The right to purchase the option shares vests 40% on April 1, 2017 and then at the rate of 5% commencing on July 1, 2017 and on each quarterly (3-month) anniversary until the right to purchase all of the shares has vested on July 1, 2020. /s/ Brian G. Fike 2017-05-16