SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 13100 MAGISTERIAL DRIVE |
| SUITE 100 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
11/07/2019
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3. Issuer Name and Ticker or Trading Symbol
CREATIVE REALITIES, INC.
[ CREX ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock, $.01 par value |
0 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
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/s/ Will Logan, as attorney-in-fact |
11/08/2019 |
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** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| 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. |
POWER OF ATTORNEY
For Executing Forms 3, 4 and 5
Know all by these presents, that the undersigned hereby
constitutes and appoints Will Logan and Brad Pederson,
signing individually, his true and lawful attorneys-in-
fact to:
1. Prepare, execute, acknowledge, and deliver in the
undersigned's name and on the undersigned's behalf, and submit
to the U.S. Securities and Exchange Commission ("SEC") a Form
ID (including any amendments or authentications thereto) or
other forms with respect to obtaining EDGAR codes and
passwords enabling the undersigned to make electronics flings
with the SEC;
2. Execute for and on behalf of the undersigned Initial
Statements of Beneficial Ownership of Securities on Form 3,
Statements of Changes of Beneficial Ownership of Securities on
Form 4 and Annual Statements of Beneficial Ownership of
Securities on Form 5, for the purpose of reporting
transactions by the undersigned in securities issued by
Creative Realities, Inc. in accordance with Section 16(a) of
the Securities Exchange Act of 1934 and the rules thereunder;
3. Do and perform any and all acts for and on behalf of the
undersigned which may be necessary or desirable to complete
the execution of any such Form 3, 4 or 5 and the timely filing
thereof with the United States Securities and Exchange
Commission and any other applicable governmental or regulatory
authority; and
4. Take any other action of any type whatsoever in connection
with the foregoing which in the opinion of such attorney-in-
fact, may be of benefit to, in the best interest of, or
legally required by, the undersigned, it being understood that
the documents executed by such attorney-in-fact on behalf of
the undersigned pursuant to this Power of Attorney shall be in
such form and shall contain such terms and conditions as such
attorney-in-fact may approve in his discretion.
The undersigned hereby grants to each such attorney-in-
fact full power and authority to do and perform all and
every act and thing whatsoever requisite, necessary and
proper to be done in the exercise of any of the rights
and powersherein granted, as fully to all intents and
purposes as such attorney-in-fact might or could do if
personally present, with full power of substitution or
revocation, hereby ratifying and confirming all that such
attorney-in-
fact, or his substitute or substitutes, shall lawfully do
or cause to be done by virtue of this power of attorney
and the rights and powers herein granted. The undersigned
acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the
undersigned, are not assuming any of the undersigned's
responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to
file Forms 3, 4 and 5 with respect to the undersigned's
holdings of and transactions in securities issued by
Creative Realities, Inc., unless earlier revoked by the
undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has executed this
Power of Attorney as of this 7th day of November, 2019.
/s/ Dennis McGill
(Signature)
Dennis McGill
(Print name)
4852-5639-4554, v. 7
