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OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
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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
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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*
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1a. IRS/SSN Identification Number of Reporting Person
 
2. Issuer Name and Ticker or Trading Symbol
{{ issuer_name }} [{{ ticker }}]
3. Date of Earliest Transaction (Month/Day/Year)
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4. If Amendment, Date of Original Filed (Month/Day/Year)
 
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
{% if is_director %}X{% else %} {% endif %} Director    {% if is_officer %}X{% else %} {% endif %} Officer (give title below)    {% if is_ten_pct_owner %}X{% else %} {% endif %} 10% Owner
{% if is_other %}X{% else %} {% endif %} Other (specify below)
{{ officer_title }}
{{ relationship_str }}
6. Individual or Joint/Group Filing (Check Applicable Line)
{% if is_individual_filing %}X{% else %} {% endif %} Form filed by One Reporting Person
{% if is_joint_filing %}X{% else %} {% endif %} Form filed by More than One Reporting Person

Table I - Non-Derivative Securities {% if form_type == '3' %}Beneficially Owned{% else %}Acquired, Disposed of, or Beneficially Owned{% endif %}

{% if form_type == '3' %} {% else %} {% endif %} {% if non_deriv_rows %} {% for row in non_deriv_rows %} {% for cell in row %} {{ cell|safe }} {% endfor %} {% endfor %} {% else %} {% endif %}
1. Title of Security (Instr. 3) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 4. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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
No non-derivative securities reported

{% if form_type == '3' %} Table II - Derivative Securities Beneficially Owned {% else %} Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned {% endif %}
(e.g., puts, calls, warrants, options, convertible securities)

{% if form_type == '3' %} {% else %} {% endif %} {% if deriv_rows %} {% for row in deriv_rows %} {% for cell in row %} {{ cell|safe }} {% endfor %} {% endfor %} {% else %} {% endif %}
1. Title of Derivative Security (Instr. 5) 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)
1. Title of Derivative Security (Instr. 5) 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 Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security 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. 5)
Code V Amount or Number of Shares (A) or (D)
No derivative securities reported
{% if remarks %}
Remarks:
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{% endif %} {% if footnotes %}

Explanation of Responses:

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  • {{ footnote.id }}: {{ footnote.text }}
  • {% endfor %}
    {% endif %}
    {% if sig_name %} {% else %} {% endif %} {% if sig_date %} {% else %} {% endif %}
    ** Signature of Reporting Person
    /s/ {{ sig_name }}
    Date
    {{ sig_date }}
    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.
    {% endblock %}