0001181431-12-067468.txt : 20121228 0001181431-12-067468.hdr.sgml : 20121228 20121228164345 ACCESSION NUMBER: 0001181431-12-067468 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121126 FILED AS OF DATE: 20121228 DATE AS OF CHANGE: 20121228 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: 121291388 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 rrd363993.xml LEVINE F4 X0306 4 2012-11-26 0 0001524025 TILLY'S, INC. TLYS 0001548775 LEVINE TILLY C/O TILLY'S, INC. 10 WHATNEY IRVINE CA 92618 0 0 1 0 Class B Common Stock 2012-11-26 5 G 0 350000 0 D Class A Common Stock 350000 4869910 D Class B Common Stock 2012-12-04 5 G 0 330000 0 D Class A Common Stock 330000 4539910 D 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. On November 26, 2012, the Reporting Person gifted 350,000 shares of the Issuer's Class B Common Stock to a limited liability company (the "LLC") in exchange for a minority membership interest in the LLC. Following the transfer, the Reporting Person does not have voting or investment control over, and does not directly or indirectly beneficially own, such shares. 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 thus disclaims beneficial ownership of such Shares. /s/ Chris Lal, Attorney-in-Fact for Tilly Levine 2012-12-28