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) 11/24/2003
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3. Issuer Name and Ticker or Trading Symbol
CONNS INC
[ CONN ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
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 |
676,804 |
I |
By voting trust |
Common Stock |
451,176 |
I |
By LLC |
Common Stock |
182,609 |
I |
By LLC |
Common Stock |
36,122 |
I |
By LLC |
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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Todd Ferguson, attorney in fact for reporting person |
11/24/2003 |
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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 MEN BY THESE PRESENTS, that the undersigned
hereby constitutes and appoints David A. Knight,
William B. Keisler and Todd C. Ferguson his true and
lawful attorneys-in-fact to:
(1) execute, for and on behalf of the undersigned,
any one or more Forms 3, 4, and 5 in accordance with
Section 16(a) of the Securities and Exchange Act of 1934,
as amended, and the rules thereunder;
(2) do and perform any and all acts, for and on behalf
of the undersigned, that may be necessary or desirable
to complete the execution of any such Form 3, 4 or 5 and
the timely filing of such form with the United States
Securities and Exchange Commission and any other
authority; and
(3) take any other action of any type whatsoever in
connection with the foregoing that, in the opinion of
any 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 the foregoing
attorneys-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 powers herein granted, as fully to all
intents and purposes as such attorneys-in-fact might or
could do if personally present, with full power of
substitution or revocation, hereby ratifying and
confirming all that such attorneys-in-fact, or their
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 and Exchange
Act of 1934, as amended, or other applicable securities
laws or rules.
IN WITNESS WHEREOF, the undersigned has caused this Power
of Attorney to be executed as of this 2nd day of January,
2002.
/s/ Jon E. M. Jacoby
Signature
Jon E. M. Jacoby
Printed Name