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