05/12/2025 | Press release | Distributed by Public on 05/12/2025 17:31
FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Peterson James J C/O MOBIX LABS, INC. 1 VENTURE PLAZA, SUITE 220 IRVINE, CA 92618 |
X | X |
/s/ Terri Aprati, Attorney-in-Fact | 05/12/2025 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | These Restricted Stock Units ("RSUs") were granted to the Reporting Person on April 11, 2025 and are fully vested on the grant date. These RSUs will settle and be delivered on the earlier of: (i) Participant's separation from service; (ii) Participant's disability; (iii) Participant's death; (iv) Change in Control of the Company; (v) occurrence of an unforeseeable emergency for the Participant as defined under Section 409A of the Internal Revenue Code; or (vi) on the following dates: (a) 350,000 RSUs on April 4, 2026; (b) 350,000 RSUs on July 1, 2026; and (c) 350,000 RSUs on November 1, 2026. |
(2) | On April 14, 2025, the Reporting Person filed a Form 4 with an incorrect footnote on the award given due to an administrative error. This amendment reflects the correct footnote for the award. |