0001144204-17-034214.txt : 20170627 0001144204-17-034214.hdr.sgml : 20170627 20170627060412 ACCESSION NUMBER: 0001144204-17-034214 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170623 FILED AS OF DATE: 20170627 DATE AS OF CHANGE: 20170627 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: 17931105 MAIL ADDRESS: STREET 1: 12870 INTERURBAN AVENUE SOUTH CITY: SEATTLE STATE: WA ZIP: 98168 4 1 v469735_4.xml OWNERSHIP DOCUMENT X0306 4 2017-06-23 0 0001434524 CLEARSIGN COMBUSTION CORP CLIR 0001563443 Ruiz Roberto 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 0 1 0 0 Chief Operating Officer Option to Purchase Common Stock 3.80 2017-06-23 4 A 0 10000 0.00 A 2027-04-01 Common Stock 10000 121500 D The right to purchase the option shares vests at the rate of 6.25% commencing on June 30, 2017 and continuing thereafter on the last day of each quarter until the right to purchase all of the option shares has vested. /s/ Roberto Ruiz 2017-06-26