Form 3 Liberty Tax, Inc. For: Sep 06 Filed by: Bates Nicholas

September 8, 2017 4:57 PM
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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1. Name and Address of Reporting Person *
Bates Nicholas

(Last) (First) (Middle)
1715 CORPORATE LANDING PARKWAY

(Street)
VIRGINIA BEACH VA 23454

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/06/2017
3. Issuer Name and Ticker or Trading Symbol
Liberty Tax, Inc. [ TAX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP, Finance
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Restricted Stock Units (2) (2) Class A Common Stock 5,342 (1) D
Restricted Stock Units (3) (3) Class A Common Stock 2,676 (1) D
Employee Stock Options (Right to Buy) 09/28/2016 09/28/2021 Class A Common Stock 9,000 22.98 D
Employee Stock Options (Right to Buy) 09/28/2017 09/28/2022 Class A Common Stock 9,000 22.98 D
Employee Stock Options (Right to Buy) 09/28/2018 09/28/2023 Class A Common Stock 9,000 22.98 D
Explanation of Responses:
1. Each Restricted Stock Unit represents the right to receive, at settlement, one share of Class A Common Stock.
2. Issuer has awarded the Reporting Person a one-time retention grant of Restricted Stock Units. One-half of the Restricted Stock Units vest on March 1, 2018 and the other half of the Restricted Stock Units vest on September 1, 2018.
3. Each year for three years starting December 9, 2017, one-third of the Restricted Stock Units shall become vested provided that the Employee is in the employ of the Company at the time of vesting.
Nicholas Bates 09/08/2017
** 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 4 (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).
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