Statement of Changes in Beneficial Ownership (4)

Date : 02/14/2020 @ 10:01PM
Source : Edgar (US Regulatory)
Stock : ClearSign Technologies Corporation (CLIR)
Quote : 0.5265  -0.0318 (-5.70%) @ 9:30PM
ClearSign Technologies share price Chart

Statement of Changes in Beneficial Ownership (4)

FORM 4 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).         
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
                                                                                  
OMB APPROVAL
OMB Number: 3235-0287
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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
                      

1. Name and Address of Reporting Person *

Deller Colin James
2. Issuer Name and Ticker or Trading Symbol

ClearSign Technologies Corp [ CLIR ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                    _____ 10% Owner
__X__ Officer (give title below)    _____ Other (specify below)
Chief Executive Officer
(Last)          (First)          (Middle)

12870 INTERURBAN AVENUE SOUTH
3. Date of Earliest Transaction (MM/DD/YYYY)

2/12/2020
(Street)

SEATTLE, WA 98168
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
6. Individual or Joint/Group Filing (Check Applicable Line)

_X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security3. Trans. Date3A. Deemed Execution Date, if any4. Trans. Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)11. Nature of Indirect Beneficial Ownership (Instr. 4)
CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Option to Purchase Common Stock $0.94 2/12/2020  A   182730     (1)1/1/2030 Common Stock 182730 $0.00 782730 D  
Option to Purchase Common Stock $1.16            (2)1/1/2029 Common Stock 400000  600000 D  
Option to Purchase Common Stock $2.25            (2)1/1/2029 Common Stock 200000  200000 D  

Explanation of Responses:
(1) The right to purchase the option shares vested on the date of grant.
(2) The right to purchase the option shares vests in 3 equal portions in January of 2019, 2020, 2021

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Deller Colin James
12870 INTERURBAN AVENUE SOUTH
SEATTLE, WA 98168


Chief Executive Officer

Signatures
/s/ Colin J. Deller2/14/2020
**Signature of Reporting PersonDate

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