Statement of Changes in Beneficial Ownership (4)
08 Dezember 2021 - 11:04PM
Edgar (US Regulatory)
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
|
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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 * Manning Daniel E. |
2. Issuer Name and Ticker or Trading
Symbol AVALARA, INC. [ AVLR ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
VP & Chief Accounting Officer |
|
(Last)
(First)
(Middle)
255 SOUTH KING ST., SUITE 1800 |
3. Date of Earliest Transaction (MM/DD/YYYY)
12/7/2021
|
|
(Street)
SEATTLE, WA 98104
(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 |
|
Common Stock |
12/7/2021 |
|
M |
|
4692 |
A |
$13.76 |
18323 |
D |
|
|
Common Stock |
12/7/2021 |
|
M |
|
2790 |
A |
$16.60 |
21113 |
D |
|
|
Common Stock |
12/7/2021 |
|
S |
|
7482 |
D |
$147.30 (1) |
13631 |
D |
|
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
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. 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 Date |
7. 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) |
|
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|
Stock Option (right to buy) |
$13.76 |
12/7/2021 |
|
M |
|
|
4692 |
(2) |
12/13/2026 |
Common Stock |
4692 |
$0.00 |
0 |
D |
|
|
Stock Option (right to buy) |
$16.60 |
12/7/2021 |
|
M |
|
|
2790 |
(3) |
1/23/2028 |
Common Stock |
2790 |
$0.00 |
9495 |
D |
|
| Explanation of
Responses: |
| (1) |
The price reported is a
weighted average price. These shares were sold in multiple
transactions at prices ranging from $146.855 to $147.84, inclusive.
Upon request by the Issuer, any security holder thereof, or the
staff of the Securities and Exchange Commission, the Reporting
Person will provide full information regarding the number of shares
sold at each separate price within the range. |
| (2) |
25% of the total shares
subject to the option vested and became exercisable on November 20,
2017, and 1/48th of the total shares subject to the option vested
and became exercisable monthly thereafter such that the option was
fully vested and exercisable on November 30, 2020. |
| (3) |
25% of the total shares
subject to the option vested and became exercisable on January 1,
2019, and 1/48th of the total shares subject to the option vest and
become exercisable monthly thereafter such that the option is fully
vested and exercisable on January 1, 2022. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Manning Daniel E.
255 SOUTH KING ST.
SUITE 1800
SEATTLE, WA 98104 |
|
|
VP & Chief Accounting Officer |
|
Signatures
|
|
/s/ Miles Treakle,
Attorney-in-Fact |
|
12/8/2021 |
| **Signature of Reporting
Person |
Date |
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