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