0001209191-22-008686.txt : 20220211
0001209191-22-008686.hdr.sgml : 20220211
20220211101022
ACCESSION NUMBER: 0001209191-22-008686
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211231
FILED AS OF DATE: 20220211
DATE AS OF CHANGE: 20220211
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FRIEDLEY BLYTHE A
CENTRAL INDEX KEY: 0001078308
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36192
FILM NUMBER: 22617386
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CIVISTA BANCSHARES, INC.
CENTRAL INDEX KEY: 0000944745
STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022]
IRS NUMBER: 341558688
STATE OF INCORPORATION: OH
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 EAST WATER ST
STREET 2: P O BOX 5016
CITY: SANDUSKY
STATE: OH
ZIP: 44870
BUSINESS PHONE: 4196254121
MAIL ADDRESS:
STREET 1: 100 EAST WATER ST
STREET 2: P O BOX 5016
CITY: SANDUSKY
STATE: OH
ZIP: 44870
FORMER COMPANY:
FORMER CONFORMED NAME: FIRST CITIZENS BANC CORP /OH
DATE OF NAME CHANGE: 19950502
5
1
doc5.xml
FORM 5 SUBMISSION
X0306
5
2021-12-31
0
0
0
0000944745
CIVISTA BANCSHARES, INC.
CIVB
0001078308
FRIEDLEY BLYTHE A
423 WEST MAIN STREET
NEW WASHINGTON
OH
44854
0
0
0
1
Subsidiary Director
Common
2021-12-06
5
J
0
425
0.00
D
9869
I
Trusteee on Arlene M. Friedley CRUT Trust
Common
2021-12-06
5
J
0
425
0.00
A
60992
I
Trust
Common
11662
I
Trusts
Common
4766
I
TTEE on Arlene M. Friedley Trust
Common
4525
D
Transferred shares from CRUT account to Trust account.
/s/Amy L. Grant, by Power of Attorney
2022-02-11