0001209191-17-050045.txt : 20170824 0001209191-17-050045.hdr.sgml : 20170824 20170824122458 ACCESSION NUMBER: 0001209191-17-050045 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170822 FILED AS OF DATE: 20170824 DATE AS OF CHANGE: 20170824 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOOTY CHARLES WILLIAM CENTRAL INDEX KEY: 0001691359 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21625 FILM NUMBER: 171048837 MAIL ADDRESS: STREET 1: 12701 WHITEWATER DRIVE STREET 2: SUITE 200 CITY: MINNETONKA STATE: MN ZIP: 55343 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FAMOUS DAVES OF AMERICA INC CENTRAL INDEX KEY: 0001021270 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 411782300 STATE OF INCORPORATION: MN FISCAL YEAR END: 1229 BUSINESS ADDRESS: STREET 1: 12701 WHITEWATER DRIVE STREET 2: SUITE 200 CITY: MINNETONKA STATE: MN ZIP: 55343 BUSINESS PHONE: 952-294-1300 MAIL ADDRESS: STREET 1: 12701 WHITEWATER DRIVE STREET 2: SUITE 200 CITY: MINNETONKA STATE: MN ZIP: 55343 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-08-22 0 0001021270 FAMOUS DAVES OF AMERICA INC DAVE 0001691359 MOOTY CHARLES WILLIAM 12701 WHITEWATER DR SUITE 200 MINNETONKA MN 55343 1 0 0 0 Common Stock 2017-08-22 4 P 0 99 4.05 A 83355 D /s/ Charles W. Mooty 2017-08-24