0001654910-16-000004.txt : 20160517 0001654910-16-000004.hdr.sgml : 20160517 20160517140939 ACCESSION NUMBER: 0001654910-16-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20160513 FILED AS OF DATE: 20160517 DATE AS OF CHANGE: 20160517 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PERCEPTRON INC/MI CENTRAL INDEX KEY: 0000887226 STANDARD INDUSTRIAL CLASSIFICATION: OPTICAL INSTRUMENTS & LENSES [3827] IRS NUMBER: 382381442 STATE OF INCORPORATION: MI FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 47827 HALYARD DRIVE CITY: PLYMOUTH STATE: MI ZIP: 48170-2461 BUSINESS PHONE: 3134144816 MAIL ADDRESS: STREET 1: 47827 HALYARD DRIVE CITY: PLYMOUTH STATE: MI ZIP: 48170-2461 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Watza David Lawrence CENTRAL INDEX KEY: 0001655189 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-20206 FILM NUMBER: 161656977 MAIL ADDRESS: STREET 1: 47827 HALYARD DRIVE CITY: PLYMOUTH STATE: MI ZIP: 48170 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2016-05-13 0 0000887226 PERCEPTRON INC/MI PRCP 0001655189 Watza David Lawrence 47827 HALYARD DRIVE PLYMOUTH MI 48170 0 1 0 0 Sr. VP & CFO Common Stock 2016-05-13 4 A 0 1000 4.85 A 3000 D Exhibit List Exhibit 24 - Power of Attorney Michelle O. Wright on behalf of David Lawrence Watza 2016-05-17 EX-24 2 watzapoa.txt POWER OF ATTORNEY Exhibit 24 POWER OF ATTORNEY For Executing Forms 3, 4 and 5 The undersigned hereby constitutes and appoints each of David Watza, Michelle Wright, Thomas Vaughn and Sylvia Smith, acting singly, as his true and lawful attorney in fact to: (1) execute for and on behalf of the undersigned Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder; and (2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete the execution of any such Form 3, 4 or 5 and the timely filing of such form with the United States Securities and Exchange Commission and any other person or authority. The undersigned hereby grants to each such attorney in fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary and proper to be done in the exercise of any of the rights and powers herein granted, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney in fact, or his/her substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the above named attorneys in fact, in serving in such capacity at the request of the undersigned, are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 10th day of November, 2015. Signature: /s/ David Lawrence Watza Printed Name: David Lawrence Watza