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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/30/2014
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3. Issuer Name and Ticker or Trading Symbol
Investar Holding Corp
[ ISTR ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
See Remarks |
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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 |
1,501.322 |
D |
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COMMON STOCK
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893 |
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/ Travis M. Lavergne |
06/30/2014 |
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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. |
INVESTAR HOLDING CORPORATION
POWER OF ATTORNEY
THE UNDERSIGNED hereby appoints the Corporate Secretary, any Assistant Corporate
Secretary, and the Chief Accounting Officer of Investar Holding Corporation (the
"Company") (individually, an "Agent"), each with the power to act individually,
as the Undersigned's true and lawful attorney-in-fact, possessing the power and
authority as follows:
To execute for and on behalf of the Undersigned, in the
Undersigned's capacity as an officer or director of the Company
and the Bank, Forms 3, 4, and 5 in accordance with Section 16 of
the Securities Exchange Act of 1934, as amended (the "Exchange
Act");
To do and perform any and all acts for and on behalf of the
Undersigned that may be necessary or desirable to complete and
execute such forms, to complete and execute any amendments
thereto, and to timely file such forms and amendments with the
Securities and Exchange Commission and any stock exchange or
similar authority; and
iii. To take any other action in connection with the foregoing
matters, which may be in the best interest of or legally
required by the Undersigned, it being understood and agreed that
the documents executed by the Agent hereunder shall be in such
form and shall
contain such terms and conditions as the Agent
may approve, in such Agent's discretion.
By execution below, the Undersigned hereby further grants to the Agent full
power and authority to do and perform any and all acts requisite, necessary or
proper to be done in connection with the exercise of the specific power and
authority granted herein, as the Undersigned might do if personally present,
with full power of substitution or revocation, hereby ratifying and confirming
that any and all such substitutes shall be empowered to do and exercise the
rights and powers granted herein.
By execution below, the Undersigned acknowledges that neither the Agent, whether
appointed or substituted hereunder, nor the Company is assuming any of the
Undersigned's obligations to comply with Section 16 of the Exchange Act, and
that each Agent is serving hereunder solely at the request of and for the
convenience of the Undersigned. The Undersigned further agrees that this Power
of Attorney shall remain in force and effect until the Undersigned is no longer
subject to the reporting requirements imposed under Section 16 of the Exchange
Act with respect to holdings and transactions in the Company's securities, or
until earlier revoked by delivery of written notice of revocation.
IN WITNESS WHEREOF, the Undersigned has caused this Power of Attorney to be
executed and effective as of the date set forth below:
/s/ Travis M. Lavergne Patrice B. Theriot
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Signature Witness
Travis M. Lavergne Ana Rupnik
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Print Name Witness
Date : June 27, 2014
SWORN TO AND SUBSCRIBED BEFORE ME this 27th day of June, 2014.
Angela Powell
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Notary Public