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