Statement of Changes in Beneficial Ownership (4)
January 03 2018 - 5:05PM
Edgar (US Regulatory)
FORM 4
[
X
]
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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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
HENCHEL GREGORY J
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2. Issuer Name
and
Ticker or Trading Symbol
HSN, Inc.
[
HSNI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Chief Legal Officer, Secretary
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(Last)
(First)
(Middle)
C/O HSN, INC., 1 HSN DRIVE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/29/2017
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(Street)
ST. PETERSBURG, FL 33729
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, par value $0.01 per share
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12/29/2017
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D
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21790.102
(1)
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D
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(2)
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0
(2)
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D
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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. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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Restricted Stock Units
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(3)
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12/29/2017
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D
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7466.74
(3)
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(4)
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(4)
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Common Stock, par value $0.01 per share
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7466.74
(3)
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(3)
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0
(3)
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D
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Share Appreciation Right
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$25.86
(5)
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12/29/2017
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D
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8150
(5)
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2/9/2012
(6)
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2/9/2021
(6)
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Common Stock, par value $0.01 per share
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8150
(5)
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(5)
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0
(5)
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D
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Share Appreciation Right
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$31.00
(5)
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12/29/2017
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D
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13322
(5)
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2/21/2013
(6)
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2/21/2022
(6)
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Common Stock, par value $0.01 per share
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13322
(5)
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(5)
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0
(5)
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D
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Share Appreciation Right
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$51.58
(5)
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12/29/2017
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D
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7624
(5)
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2/12/2014
(6)
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2/12/2023
(6)
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Common Stock, par value $0.01 per share
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7624
(5)
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(5)
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0
(5)
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D
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Share Appreciation Right
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$47.72
(5)
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12/29/2017
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D
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12277
(5)
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2/12/2015
(6)
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2/12/2024
(6)
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Common Stock, par value $0.01 per share
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12277
(5)
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(5)
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0
(5)
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D
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Share Appreciation Right
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$65.24
(5)
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12/29/2017
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D
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14670
(5)
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2/10/2016
(6)
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2/10/2025
(6)
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Common Stock, par value $0.01 per share
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14670
(5)
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(5)
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0
(5)
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D
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Share Appreciation Right
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$44.86
(5)
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12/29/2017
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D
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31191
(5)
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2/16/2017
(6)
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2/16/2026
(6)
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Common Stock, par value $0.01 per share
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31191
(5)
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(5)
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0
(5)
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D
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Share Appreciation Right
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$38.80
(5)
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12/29/2017
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D
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34390
(5)
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2/23/2018
(6)
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2/23/2027
(6)
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Common Stock, par value $0.01 per share
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34390
(5)
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(5)
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0
(5)
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D
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Explanation of Responses:
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(1)
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Amount of Securities reflects an adjustment of 91.258 shares as a result of an error previously reported on Form 4 filed on February 14, 2017 with respect to shares acquired under the company's employee stock purchase plan.
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(2)
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Per the terms of the Agreement and Plan of Merger, dated as of July 5, 2017, by and among HSN, Inc., a Delaware corporation ("HSNI"), Liberty Interactive Corporation, a Delaware corporation, and Liberty Horizon, Inc., a Delaware corporation and a direct, wholly-owned subsidiary of Liberty Interactive (the "Merger Agreement"), each share of HSNI common stock was converted to 1.65 shares of Liberty Interactive Series A QVC Group common stock ("Liberty QVCA common stock") rounded down to the nearest number of whole shares with any fractional shares being paid out in cash based on the market closing price of Liberty QVCA common stock on December 29, 2017.
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(3)
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Each Restricted Stock Unit ("RSU") is the economic equivalent of one share of HSNI common stock. Per the terms of the Merger Agreement, each RSU was converted into an RSU equivalent to 1.65 shares of Liberty QVCA common stock and rounded to the nearest whole share.
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(4)
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Per the terms of the award agreement, upon the occurrence of the later of (i) the effective time of the Merger Agreement and (ii) the individual's separation from service, each unvested RSU becomes fully vested.
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(5)
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Per the terms of the Merger Agreement, the Share Appreciation Right ("SAR") was converted into a SAR for shares of Liberty QVCA common stock by multiplying the number of shares in Table II, Column 7 by 1.65 (rounded down to the nearest number of whole shares) at an exercise price per share equal to the exercise price in Table II, Column 2 divided by 1.65 and rounded up to the nearest whole cent.
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(6)
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Per the terms of the award agreement: (i) to the extent unvested, the award will vest upon the occurrence of the later of (a) the effective time of the Merger Agreement and (b) the individual's separation from service, and (ii) after a change of control and separation from service, the SAR expires on the earlier of (c) the original expiration date of the SAR or (d) one year following the individual's separation from service.
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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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HENCHEL GREGORY J
C/O HSN, INC.
1 HSN DRIVE
ST. PETERSBURG, FL 33729
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Chief Legal Officer, Secretary
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Signatures
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/s/ Harold Herman, as attorney-in-fact
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1/3/2018
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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 4(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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