| 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 04/25/2016 |
3. Issuer Name and Ticker or Trading Symbol
CRACKER BARREL OLD COUNTRY STORE, INC [ CBRL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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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)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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) |
| Common Stock | 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) | 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 | ||||
| Explanation of Responses: |
| Jill Golder by Michael J. Zylstra, Attorney-in-fact | 04/27/2016 | |
| ** 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
KNOW ALL MEN BY THESE PRESENTS, that the undersigned, Jill Golder, hereby appoints Michael Zylstra to be the undersigned's true and lawful attorney, for her, and in her name, place and stead to execute, acknowledge, deliver and file, by mail, delivery service or electronically, Forms 3, 4 and 5 (including amendments to those forms) with respect to securities of Cracker Barrel Old Country Store, Inc. (the "Company") required to be filed with the Securities and Exchange Commission, national securities exchanges and the Company pursuant to Section 16(a) of the Securities Exchange Act of 1934 and the rules and regulations under that Act, granting to Michael Zylstra full power and authority to perform all acts necessary to the completion of those purposes.
The undersigned agrees that the attorney-in-fact, Michael Zylstra, may rely entirely on information furnished orally or in writing by the undersigned to any specified attorney-in-fact. The undersigned also agrees to indemnify and hold the Company and the attorney-in-fact harmless against any losses, claims, damages or liabilities (or actions or proceedings in these respects) that arise out of or are based upon any untrue statements or omission of necessary facts in the information provided by the undersigned to the attorney-in-fact for any legal or other expenses reasonably incurred in connection with investigating, defending against or resolving any such loss, claim, damage, liability or action.
The validity of this Power of Attorney shall not be affected in any manner by reason of the execution, at any time, of other powers of attorney by the undersigned in favor of persons other than those named in this document.
The undersigned agrees and represents to those dealing with my attorney-in-fact, Michael Zylstra, that this Power of Attorney is for indefinite duration and may be voluntarily revoked by me only by written notice to the specified attorney-in-fact, delivered by registered mail or certified mail, return receipt requested.
WITNESS THE EXECUTION OF THIS POWER on April 5, 2016.
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/s/ Jill Golder
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Jill Golder
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