SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF 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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
07/11/2023
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3. Issuer Name and Ticker or Trading Symbol
Zumiez Inc
[ ZUMZ ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock |
0.00 |
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 Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
|
Chris Visser, as Attorney-in-Fact for Guy Matthew Harkless |
07/12/2023 |
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** Signature of Reporting Person |
Date |
| 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
5
(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). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| 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 Number. |
Power of Attorney
1. Designation of Attorneys-in-Fact. The
undersigned, hereby designates Chris K. Visser, an
individual with full power of substitution, as my
attorney-in-fact to act for me and in my name, place
and stead, and on my behalf in connection with the
matters set forth in Item 2 below.
2. Powers of Attorney-in-Fact. Each attorney-
in-fact, as fiduciary, shall have the authority to
prepare, execute in the undersigned's name and on
the undersigned's behalf, and submit to the U.S.
Securities and Exchange Commission (the "SEC") a
Form ID, including amendments thereto, and any
other documents necessary or appropriate to obtain
codes and passwords enabling the undersigned to make
electronic filings with the SEC of reports required
by Section 16(a) of the Securities Exchange Act of 1934
or any rule or regulation of the SEC.
Furthermore, each attorney-in-fact, as fiduciary, shall
have the authority to sign all such SEC reports, forms
and other filings, specifically including but not
limited to Forms 3, 4, 5 and 144, as such attorney-in-fact
deems necessary or desirable in connection with the
satisfaction of my reporting obligations under the rules
and regulations of the SEC.
3. Effectiveness. This power of attorney shall
become effective upon the execution of this document.
4. Duration. This power of attorney shall remain
in effect until revoked by me in a writing delivered
to Chris K. Visser. This power of attorney shall not
be affected by disability of the principal.
5. Revocation. This power of attorney may be
revoked in writing at any time by my giving written
notice to the attorney-in-fact. If this power of
attorney has been recorded, the written notice of
revocation shall also be recorded.
Date: June 26, 2023
__Guy Matthew Harkless____
Guy Matthew Harkless
STATE OF FLORIDA )
COUNTY OF Pinellas )
SIGNED OR ATTESTED before me on 06/26/2023 by Guy Matthew Harkless.
__Jordan Bradbury________
Signature of Notary Public
__Jordan Bradbury_________
(SEAL) Typed Name of Notary Public
Residing at: UPS Store #6886
My commission expires: _04/07/27_
