0001866581-23-000112.txt : 20230814
0001866581-23-000112.hdr.sgml : 20230814
20230814160412
ACCESSION NUMBER: 0001866581-23-000112
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230811
FILED AS OF DATE: 20230814
DATE AS OF CHANGE: 20230814
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tullett Victoria J
CENTRAL INDEX KEY: 0001606719
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40798
FILM NUMBER: 231169693
MAIL ADDRESS:
STREET 1: C/O DUTCH BROS INC.
STREET 2: 110 SW 4TH STREET
CITY: GRANTS PASS
STATE: OR
ZIP: 97526
FORMER NAME:
FORMER CONFORMED NAME: Blackwell Victoria T.
DATE OF NAME CHANGE: 20140429
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Dutch Bros Inc.
CENTRAL INDEX KEY: 0001866581
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING & DRINKING PLACES [5810]
IRS NUMBER: 871041305
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 110 SW 4TH STREET
CITY: GRANTS PASS
STATE: OR
ZIP: 97526
BUSINESS PHONE: (206) 390-8860
MAIL ADDRESS:
STREET 1: PO BOX 1929
CITY: GRANTS PASS
STATE: OR
ZIP: 97528-0163
4
1
wf-form4_169204344021277.xml
FORM 4
X0508
4
2023-08-11
0
0001866581
Dutch Bros Inc.
BROS
0001606719
Tullett Victoria J
C/O DUTCH BROS INC.
PO BOX 1929
GRANTS PASS
OR
97528-0163
0
1
0
0
Chief Legal Officer
0
Class A Common Stock
2023-08-11
4
P
0
739
33.80
A
739
D
/s/ Charles Jemley, Attorney-in-Fact for Victoria Tullett
2023-08-14