Initial Statement of Beneficial Ownership (3)
July 30 2018 - 6:16PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
HOFFMAN Robert Thurston Sr
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2. Date of Event Requiring Statement (MM/DD/YYYY)
7/20/2018
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3. Issuer Name
and
Ticker or Trading Symbol
CLEARSIGN COMBUSTION CORP [CLIR]
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(Last)
(First)
(Middle)
12870 INTERURBAN AVENUE SOUTH
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
SEATTLE, WA 98168
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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110519
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I
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IRA Account
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Common Stock
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5213543
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I
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See footnote
(1)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Contractual Right to Purchase Common Stock
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7/20/2018
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2/1/2019
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Contractual Right to Purchase Common Stock
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478854
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$4
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I
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See footnote
(1)
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Explanation of Responses:
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(1)
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Mr. Hoffman is the managing member of GPclirSPV LLC which is the Manager of clirSPV LLC, the owner of the Common Stock and contractual rights to purchase Common Stock. Mr. Hoffman is also the Managing Member of Princeton Opportunity Management, LLC, which has an Investment Management Agreement with clirSPV LLC. Mr. Hoffman disclaims beneficial ownership of these shares and purchase right except to the extent of his pecuniary interest in clirSPV LLC.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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HOFFMAN Robert Thurston Sr
12870 INTERURBAN AVENUE SOUTH
SEATTLE, WA 98168
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X
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X
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Signatures
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/s/ Robert T. Hoffman Sr
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7/30/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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