0001144204-12-029948.txt : 20120516
0001144204-12-029948.hdr.sgml : 20120516
20120516113706
ACCESSION NUMBER: 0001144204-12-029948
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120515
FILED AS OF DATE: 20120516
DATE AS OF CHANGE: 20120516
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35521
FILM NUMBER: 12847775
MAIL ADDRESS:
STREET 1: 100 WILSHIRE BLVD
CITY: SANTA MONICA
STATE: CA
ZIP: 90401
4
1
v313633_form4.xml
OWNERSHIP DOCUMENT
X0305
4
2012-05-15
0
0001434524
CLEARSIGN COMBUSTION CORP
CLIR
0000897744
MARLETT CHRISTOPHER A
401 WILSHIRE BLVD., SUITE 1020
SANTA MONICA
CA
90401
0
0
1
0
Common Stock Warrant
5.00
2012-05-15
4
J
0
45000
A
2013-04-24
2017-04-24
Common Stock
45000
436727
I
SEE FOOTNOTE
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.
The securities were acquired by MDB as partial compensation resulting from the exercise of underwriter's over-allotment option in connection with an underwritten public offering.
/s/ Christopher Marlett
2012-05-15