Statement of Changes in Beneficial Ownership (4)
06 Januar 2022 - 11:44PM
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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APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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 * Tennenbaum Ross |
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)
See Remarks |
|
(Last)
(First)
(Middle)
255 SOUTH KING ST., SUITE 1800 |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/5/2022
|
|
(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 |
1/5/2022 |
|
M |
|
250 |
A |
$55.10 |
64967 |
D |
|
|
Common Stock |
1/5/2022 |
|
M |
|
654 |
A |
$67.27 |
65621 |
D |
|
|
Common Stock |
1/5/2022 |
|
S(1) |
|
904 |
D |
$119.44 |
64717 |
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) |
$55.10 |
1/5/2022 |
|
M |
|
|
250 |
(2) |
4/22/2029 |
Common Stock |
250 |
$0.00 |
15667 |
D |
|
|
Stock Option (right to buy) |
$67.27 |
1/5/2022 |
|
M |
|
|
654 |
(3) |
3/12/2030 |
Common Stock |
654 |
$0.00 |
17007 |
D |
|
| Explanation of
Responses: |
| (1) |
The sale was effected
pursuant to a Rule 10b5-1 trading plan originally adopted by the
Reporting Person on March 9, 2020, and amended on February 16,
2021. |
| (2) |
25% of the total shares
subject to the option vested and became exercisable on March 4,
2020, 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 March 4, 2023. |
| (3) |
25% of the total shares
subject to the option vested and became exercisable on March 5,
2021, 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 March 5, 2024. |
Remarks:
Chief Financial Officer and Treasurer |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Tennenbaum Ross
255 SOUTH KING ST.
SUITE 1800
SEATTLE, WA 98104 |
|
|
See Remarks |
|
Signatures
|
|
/s/ Miles Treakle,
Attorney-in-Fact |
|
1/6/2022 |
| **Signature of Reporting
Person |
Date |
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