0000943034-17-000053.txt : 20171219 0000943034-17-000053.hdr.sgml : 20171219 20171219130249 ACCESSION NUMBER: 0000943034-17-000053 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171215 FILED AS OF DATE: 20171219 DATE AS OF CHANGE: 20171219 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Geoffrey Clark CENTRAL INDEX KEY: 0001689088 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35959 FILM NUMBER: 171263464 MAIL ADDRESS: STREET 1: 1929 WEDGEWOOD LANE CITY: HEBRON STATE: KY ZIP: 41048 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: IMAGE SENSING SYSTEMS INC CENTRAL INDEX KEY: 0000943034 STANDARD INDUSTRIAL CLASSIFICATION: MEASURING & CONTROLLING DEVICES, NEC [3829] IRS NUMBER: 411519168 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 500 SPRUCE TREE CENTRE STREET 2: 1600 UNIVERSITY AVE CITY: ST PAUL STATE: MN ZIP: 55104-3825 BUSINESS PHONE: 6516037700 MAIL ADDRESS: STREET 1: 500 SPRUCE TREE CENTRE STREET 2: 1600 UNIVERSITY AVE W. CITY: ST PAUL STATE: MN ZIP: 55104 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-12-15 0 0000943034 IMAGE SENSING SYSTEMS INC isns 0001689088 Davis Geoffrey Clark 1600 UNIVERSITY AVE. W. #500 ST. PAUL MN 55104 1 0 0 0 Common Stock 2017-12-15 4 A 0 1984 0 A 10749 D /s/Richard A. Ehrich, Attorney-in-fact for Geoffrey C. Davis 2017-12-19