0001209191-22-055917.txt : 20221107
0001209191-22-055917.hdr.sgml : 20221107
20221107144817
ACCESSION NUMBER: 0001209191-22-055917
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20221103
FILED AS OF DATE: 20221107
DATE AS OF CHANGE: 20221107
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: NICKLES ALLEN R
CENTRAL INDEX KEY: 0001265669
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36192
FILM NUMBER: 221365081
MAIL ADDRESS:
STREET 1: 100 EAST WATER STREET
CITY: SANDUSKY
STATE: OH
ZIP: 44870
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CIVISTA BANCSHARES, INC.
CENTRAL INDEX KEY: 0000944745
STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022]
IRS NUMBER: 341558688
STATE OF INCORPORATION: OH
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 EAST WATER ST
STREET 2: P O BOX 5016
CITY: SANDUSKY
STATE: OH
ZIP: 44870
BUSINESS PHONE: 4196254121
MAIL ADDRESS:
STREET 1: 100 EAST WATER ST
STREET 2: P O BOX 5016
CITY: SANDUSKY
STATE: OH
ZIP: 44870
FORMER COMPANY:
FORMER CONFORMED NAME: FIRST CITIZENS BANC CORP /OH
DATE OF NAME CHANGE: 19950502
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-11-03
0
0000944745
CIVISTA BANCSHARES, INC.
CIVB
0001265669
NICKLES ALLEN R
3308 E BEVERLY DRIVE
SANDUSKY
OH
44870
1
0
0
0
Common
2021-05-27
4
A
0
628
0.00
A
4585
D
Common
2022-03-03
4
S
0
5000
24.25
D
109759
I
SEP IRA
Common
2022-03-17
4
J
0
725
0.00
D
0
I
Daughter
Common
2022-05-25
4
A
0
602
0.00
A
5187
D
Common
2022-11-03
4
S
0
10000
22.754
D
99759
I
SEP IRA
/s/ Lori A. Castillo, by Power of Attorney
2022-11-07
EX-24
2
poa.txt
POA DOCUMENT
Allen R. Nickles
LIMITED POWER OF ATTORNEY
SECURITIES LAW COMPLIANCE
The undersigned hereby constitutes and appoints Lori A. Castillo and Karen M.
Terenzi as the undersigned's true and lawful attorneys-in-fact and agents to
complete and execute such Forms 144, Forms 3, 4 and 5 and other forms
(collectively, the "Reporting Forms") as such attorneys-in-fact shall, in her
discretion, determine to be required or advisable pursuant to Rule 144
promulgated under the Securities Act of 1933 (as amended), Section 16 of the
Securities Exchange Act of 1934 (as amended) and the rules and regulations
promulgated thereunder, or any successor laws and regulations (collectively,
"SEC Law"), as a consequence of the undersigned's ownership, acquisition or
disposition of securities of Civista Bancshares, Inc. (the "Corporation"), and
to do all acts necessary in order to file such forms with the Securities and
Exchange Commission (the "SEC"), any securities exchange or national
association, the Corporation and such other person or agency as the
attorneys-in-fact shall deem appropriate. Said attorneys-in-fact and agents
have the authority to act individually. The undersigned hereby ratifies and
confirms all that said attorneys-in-fact and agents shall do or cause to be done
by virtue hereof.
The undersigned acknowledges that:
(1) this Limited Power of Attorney authorizes, but does not require, the
attorneys-in-fact to act in her discretion on information provided to such
attorneys-in-fact without independent verification of such information;
(2) any Reporting Forms prepared and/or executed by the attorneys-in-fact on
behalf of the undersigned pursuant to this Limited Power of Attorney will be in
such form and will contain such information and disclosure as such
attorneys-in-fact, in his discretion, deems necessary or desirable;
(3) neither the Corporation nor the attorneys-in-fact assume (i) any liability
for the undersigned's responsibility to comply with the requirements of SEC Law,
(ii) any liability of the undersigned for any failure to comply with such
requirements, or (iii) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act;
(4) this Limited Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations under SEC Law,
including without limitation the reporting requirements under Section 16 of the
Exchange Act; and
(5) in order to execute any Reporting Forms, it is the undersigned's
responsibility to notify the attorneys-in-fact in a timely manner of any
transaction regarding the undersigned's ownership, acquisition or disposition of
Civista Bancshares, Inc. securities (SEC requires Reporting Forms to be filed
within two (2) business days of the transaction).
In such instances where the undersigned has executed any of the Reporting Forms
on his or her own behalf, the undersigned hereby consents to the filing of
copies of such Reporting Forms that reflect a conformed signature. The
undersigned will maintain fully executed copies of any Reporting Forms so filed,
in his or her own records.
This Limited Power of Attorney is executed at Sandusky, Ohio as of the date set
forth below.
Date: September 27, 2022
Allen R. Nickles
State of OHIO
County of Erie
On this 27th day of September, 2022, before me, the undersigned notary public,
appeared Allen R. Nickles, personally known to me or proved to me on the basis
of satisfactory evidence to be the individual whose name is subscribed to the
within instrument, and acknowledge to me that he executed the same.