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) 05/06/2016
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3. Issuer Name and Ticker or Trading Symbol
BlackRock Capital Investment Corp
[ BKCC ]
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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, par value $0.001 per share |
65,000 |
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/ Laurence D. Paredes as Attorney-in-Fact |
05/16/2016 |
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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. |
Unassociated Document
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS that the undersigned
hereby constitutes, designates and appoints Laurence D. Paredes and Donna Milia
of BlackRock Capital Investment Corporation (the "Company"), and Michael K.
Hoffman, Steven Grigoriou and Boris Rappoport of Skadden, Arps, Slate, Meagher
& Flom LLP as such person's true and lawful attorneys-in-fact and agents,
each with full power of substitution and resubstitution and full power to act
alone and without the other, for the undersigned and in the undersigned's name,
place and stead, in any and all capacities, to execute, acknowledge, deliver and
file any and all statements on Form ID (including, but not limited to, obtaining
the Central Index Key ("CIK") and the CIK confirmation code ("CCC") from the
Securities and Exchange Commission), Form 3, Form 4 and Form 5 and any successor
forms adopted by the Securities and Exchange Commission, as may be required by
the Securities Act of 1933, the Securities Exchange Act of 1934 and the
Investment Company Act of 1940 and the rules thereunder, and requisite documents
in connection with such statements, respecting the Company. This power of
attorney supersedes any previous versions of same, and shall be valid from the
date hereof until revoked by the undersigned, and shall be automatically revoked
with respect to any attorney in the event that such attorney is no longer
affiliated with Skadden, Arps, Slate, Meagher & Flom LLP or the Company or
its affiliates (as the case may be).
IN WITNESS WHEREOF, the undersigned has executed this
instrument as of May 13, 2016.
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By:
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/s/ Mark S. Lies
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Print:
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Mark S. Lies
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