0001181431-12-029237.txt : 20120510 0001181431-12-029237.hdr.sgml : 20120510 20120510195201 ACCESSION NUMBER: 0001181431-12-029237 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120509 FILED AS OF DATE: 20120510 DATE AS OF CHANGE: 20120510 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LEVINE TILLY CENTRAL INDEX KEY: 0001548775 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35535 FILM NUMBER: 12831906 MAIL ADDRESS: STREET 1: C/O TILLY'S, INC. STREET 2: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TILLY'S, INC. CENTRAL INDEX KEY: 0001524025 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-APPAREL & ACCESSORY STORES [5600] IRS NUMBER: 452164791 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: (949) 609-5599 MAIL ADDRESS: STREET 1: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 4 1 rrd344649.xml LEVINE F4 X0305 4 2012-05-09 0 0001524025 TILLY'S, INC. TLYS 0001548775 LEVINE TILLY C/O TILLY'S, INC. 10 WHATNEY IRVINE CA 92618 0 0 1 0 CLASS A COMMON STOCK 2012-05-09 4 C 0 480000 0 A 480000 D CLASS A COMMON STOCK 2012-05-09 4 S 0 480000 14.415 D 0 D CLASS B COMMON STOCK 2012-05-09 4 C 0 480000 0 D CLASS A COMMON STOCK 480000 5520000 D The shares reported herein are held in The Tilly Levine Separate Property Trust under which the Reporting Person is trustee and beneficiary. The Reporting Person has entered into a voting trust agreement with Hezy Shaked, an officer and director of the Issuer, granting Mr. Shaked, as trustee under such agreement, the right to vote the shares of Class A Common Stock and Class B Common Stock beneficially owned by the Reporting Person (collectively, the "Shares"). Mr. Shaked does not have any pecuniary interest in such Shares and thus disclaims beneficial ownership of such Shares for purposes of Section 16 or for any other purpose. Class B Common Stock has no expiration date and, subject to certain events, is automatically convertible on a one-for-one basis into shares of Class A Common Stock. The shares of Class B Common Stock reported on this line item converted into the Issuer's Class A Common Stock on a one-for-one basis upon the closing of the Issuer's initial public offering and sale to the underwriters. Represents the public offering price of $15.50 per share of Class A Common Stock less the underwriter's discount of $1.085 per share of Class A Common Stock. /s/ PATRICK GROSSO, ATTORNEY-IN-FACT FOR TILLY LEVINE 2012-05-10 /s/ PATRICK GROSSO, ATTORNEY-IN-FACT FOR HEZY SHAKED 2012-05-10