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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1. Name and Address of Reporting Person*
Brentwood-Zumiez Investors, LLC

(Last) (First) (Middle)
11150 SANTA MONICA BLVD.
SUITE 1200

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/05/2005
3. Issuer Name and Ticker or Trading Symbol
Zumiez Inc [ ZUMZ ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common stock 4,296,530 D
Common stock 4,296,530 I See footnote(1)
Common stock 4,296,530 I See footnote(2)
Common stock 4,296,530 I See footnote(3)
Common stock 4,296,530 I See footnote(4)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
Brentwood-Zumiez Investors, LLC

(Last) (First) (Middle)
11150 SANTA MONICA BLVD.
SUITE 1200

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
BAPE III EXECUTIVE FUND L P

(Last) (First) (Middle)
11150 SANTA MONICA BLVD.
SUITE 1200

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
BRENTWOOD ASSOCIATES PRIVATE EQUITY III LP

(Last) (First) (Middle)
11150 SANTA MONICA BLVD.
SUITE 1200

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Brentwood Associates Private Equity III-A, L.P.

(Last) (First) (Middle)
11150 SANTA MONICA BLVD.
SUITE 1200

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Brentwood Private Equity III, LLC

(Last) (First) (Middle)
11150 SANTA MONICA BLVD.
SUITE 1200

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
Explanation of Responses:
1. Reflects securities held by Brentwood-Zumiez Investors, LLC. Brentwood Private Equity III, LLC is the general partner of Brentwood Associates Private Equity III, L.P., Brentwood Associates Private Equity III-A, L.P. and BAPE III Executive Fund, L.P., which collectively hold all of the membership interests of Brentwood-Zumiez Investors, LLC.
2. Reflects securities held by Brentwood-Zumiez Investors, LLC, of which BAPE III Executive Fund, L.P. is a member. BAPE III Executive Fund, L.P. disclaims beneficial ownership of these securities, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such reporting person is the beneficial owner of the securities for Section 16 purposes or for any other purpose.
3. Reflects securities held by Brentwood-Zumiez Investors, LLC, of which Brentwood Associates Private Equity III, L.P. is a member. Brentwood Associates Private Equity III, L.P. disclaims benefical ownership of these securities, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such reporting person is the beneficial owner of the securities for Section 16 purposes or for any other purpose.
4. Reflects securities held by Brentwood-Zumiez Investors, LLC, of which Brentwood Associates Private Equity III-A, L.P. is a member. Brentwood Associates Private Equity III-A, L.P. disclaims benefical ownership of these securities, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such reporting person is the beneficial owner of the securities for Section 16 purposes or for any other purpose.
William M. Barnum, Jr., authorized representative 05/05/2005
William M. Barnum, Jr., authorized representative 05/05/2005
William M. Barnum, Jr., authorized representative 05/05/2005
William M. Barnum, Jr., authorized representative 05/05/2005
William M. Barnum, Jr., authorized representative 05/05/2005
** 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).
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