Form SEC 1474 SEC 1474 Form 4 - Statement of Changes In Beneficial Ownership

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 4
Check this box if no longer
subject to Section 16. Form 4 or Form
5 obligations may continue.
See Instruction 1(b).

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STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

Check this box to indicate that a transaction was made pursuant to
a contract, instruction or written plan that is intended to satisfy the
affirmative defense conditions of Rule 10b5-1(c).
See Instruction 10.
(Print or Type Responses)

1. Name and Address of Reporting Person*

(Last)

(First)

(Middle)

(Street)

(City)
1. Title of Security
(Instr. 3)

(State)

5. Relationship of Reporting Person(s) to Issuer

2. Issuer Name and Ticker or Trading Symbol

3. Date of Earliest
Transcaction Required
to be Reported
(Month/Day/Year)

(Zip)
2. Transaction
Date

(Month/
Day/
Year)

(Check all applicable)

4. If Amendment,
Date Original
Filed(Month/Day/Year)

Director
Officer (give
title below)

10% Owner
Other (specify
below)

6. Individual or Joint/Group Filing (Check Applicable Line)
__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
2A. Deemed 3. TransExecution
action
Date, if any Code
(Month/
(Instr. 8)
Day/Year)

Code

V

4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)

Amount

(A) or
(D)

Price

5. Amount of
6. Owner- 7. Nature of
Indirect
Securities
ship
Beneficial
Beneficially
Form:
Ownership
Owned FollowDirect
ing Reported
(D) or
Transaction (s)
Indirect
(Instr. 4)
(Instr. 3 and 4)
(I) (Instr. 4)

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
Potential persons who are to 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.

(Over)
SEC 1474 (02-23)

FORM 4 (continued)
1. Title of Derivative 2. ConverSecurity
sion or
(Instr. 3)
Exercise
Price of
Derivative
Security

Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g., puts, calls, warrants, options, convertible securities)
3. Trans- 3A. Deemed 4. Trans- 5. Number of Derivaction Execution
action
ative Securities
Date
Date, if
Code
Ac-quired (A) or
any
(Instr. 8)
Dis-posed of (D)
(Month/ (Month/
(Instr. 3, 4, and 5)
Day/
Day/
Year)
Year)

6. Date Exercisable and
Expiration
Date
(Month/Day/
Year)

Date
Exercisable
Code V

(A)

Expiration
Date

7. Title and Amount of Underly- 8. Price 9. Number 10.Owner- 11. Nature
of
of derivship
of Indiing Securities
Deriv- ative
Form of
rect
(Instr. 3 and 4)
ative
SecurDerivBenSecurities
ative
eficial
ity
BeneSecurity:
Owner(Instr.
Direct
ficially
ship
5)
(D) or
Owned
(Instr. 4)
Indirect
following
(I)
Reported
Trancsact (Instr. 4)
Amount or
ion(s)
Title Number of
(Instr. 4)
Shares

(D)

Explanation of Responses:

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

**Signature of Reporting Person

Date

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form are not
required to respond unless the form displays a currently valid OMB Number.
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