0001181431-12-062914.txt : 20121206 0001181431-12-062914.hdr.sgml : 20121206 20121206180437 ACCESSION NUMBER: 0001181431-12-062914 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121204 FILED AS OF DATE: 20121206 DATE AS OF CHANGE: 20121206 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: 121247730 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 rrd362426.xml TILLY F4 12-4-12 X0306 4 2012-12-04 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 2012-12-04 4 C 0 44309 0 A 44309 D Class A Common Stock 2012-12-04 4 S 0 44309 13.1722 D 0 D Class A Common Stock 2012-12-05 4 C 0 50000 0 A 50000 D Class A Common Stock 2012-12-05 4 S 0 50000 13.2729 D 0 D Class B Common Stock 2012-12-04 4 C 0 44309 0 D Class A Common Stock 44309 5269910 D Class B Common Stock 2012-12-05 4 C 0 50000 0 D Class A Common Stock 50000 5219910 D The price reported in Column 4 is a weighted average price. These shares were acquired in multiple transactions at prices ranging from $13.00 to $13.25, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares acquired at each separate price within the ranges set forth in this footnote. 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 reported in Box 9 are held in The Tilly Levine Separate Property Trust under which the Reporting Person is trustee and beneficiary. The Reporting Person is a party to 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 held by the Reporting Person (collectively, the "Shares"). Mr. Shaked does not have any pecuniary interest in such Shares and this disclaims beneficial ownership of such Shares. The price reported in Column 4 is a weighted average price. These shares were acquired in multiple transactions at prices ranging from $13.19 to $13.39, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares acquired at each separate price within the ranges set forth in this footnote. /s/ Chris Lal, Attorney-in-Fact for Tilly Levine 2012-12-06