0001144204-12-025213.txt : 20120501
0001144204-12-025213.hdr.sgml : 20120501
20120501134755
ACCESSION NUMBER: 0001144204-12-025213
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120424
FILED AS OF DATE: 20120501
DATE AS OF CHANGE: 20120501
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CLEARSIGN COMBUSTION CORP
CENTRAL INDEX KEY: 0001434524
STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823]
IRS NUMBER: 000000000
STATE OF INCORPORATION: WA
BUSINESS ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
BUSINESS PHONE: (206) 673-4848
MAIL ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MARLETT CHRISTOPHER A
CENTRAL INDEX KEY: 0000897744
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35521
FILM NUMBER: 12799306
MAIL ADDRESS:
STREET 1: 100 WILSHIRE BLVD
CITY: SANTA MONICA
STATE: CA
ZIP: 90401
3
1
v311416_3.xml
OWNERSHIP DOCUMENT
X0205
3
2012-04-24
0
0001434524
CLEARSIGN COMBUSTION CORP
CLIR
0000897744
MARLETT CHRISTOPHER A
401 WILSHIRE BLVD.
SANTA MONICA
CA
90401
0
0
1
0
Common Stock
74573
D
Common Stock
454545
I
See Footnote
Common Stock
289207
I
See Footnote
Common Stock Warrants
2.20
2011-05-10
2016-05-10
Common Stock
17409
D
Common Stock Warrants
2.20
2011-05-10
2016-05-10
Common Stock
74318
I
See Footnote
Common Stock Warrants
5.00
2013-04-24
2017-04-24
Common Stock
300000
I
See Footnote
The record holder of these securities is Integrated Surgical Systems, Inc. ("ISS"). The reporting person is the Chief Executive Officer and a director of ISS. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be an admission of beneficial ownership of all of the reported securities for purposes of Section 16 or for any other purpose.
The record holder of these securities is MDB Capital Group LLC ("MDB"). The reporting person is the Chief Executive Officer of MDB. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be an admission of beneficial ownership of all of the reported securities for purposes of Section 16 or for any other purpose.
/s/ Christopher Marlett
2012-04-30