Form 144

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 144

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NOTICE OF PROPOSED SALE OF SECURITIES

PURSUANT TO RULE 144 UNDER THE SECURITIES ACT OF 1933

  SEC USE ONLY
 
 

DOCUMENT SEQUENCE NO.

 

ATTENTION:    Transmit for filing 3 copies of this form concurrently with either placing an order with a broker to execute sale or executing a sale directly with a market maker

  CUSIP NUMBER
   

WORK LOCATION

 

1(a) NAME OF ISSUER (Please type or print)

        AMERISAFE, Inc.

 

(b) IRS IDENT. NO.

        75-2069407

      

(c) S.E.C. FILE NO.

        000-51520

1(d) ADDRESS OF ISSUER    STREET   

CITY

   STATE    ZIP CODE       (e) TELEPHONE NO.
2301 Highway 190 West, DeRidder, Louisiana 70634            AREA CODE    NUMBER
              337    463-9052

2(a) NAME OF PERSON FOR WHOSE

        ACCOUNT THE SECURITIES

        ARE TO BE SOLD

  

(b) IRS IDENT. NO.

  (c) RELATIONSHIP TO ISSUER    (d) ADDRESS  

STREET

  

CITY

  

STATE

  

ZIP CODE

        C. Allen Bradley, Jr.        Officer    2301 Highway 190 West, DeRidder, Louisiana 70634

INSTRUCTION: The person filing this notice should contact the issuer to obtain the I.R.S. Identification Number and the S.E.C. File Number.

 

3(a)

   (b)         SEC USE ONLY    (c)    (d)    (e)    (f)    (g)

Title of the

Class of

Securities

To Be Sold

  

Name and Address of Each Broker

Through Whom the Securities are

to be Offered or Each Market

Maker who is Acquiring

the Securities

  

Broker-Dealer

File Number

  

Number of Shares

or Other Units

To Be Sold

(See Instr. 3(c))

  

Aggregate

Market Value

(See Instr. 3(d))

  

Number of Shares

or Other Units

Outstanding

(See Instr. 3(e))

  

Approximate

Date of Sale

(See Instr. 3(f))

(MO. DAY YR.)

  

Name of Each

Securities

Exchange

(See Instr. 3(g))

Common stock, par value $.01   

Folio fn Investments, Inc.

PO Box 953625

St. Louis, MO 63195

        3,000    $55,170 as of December 5, 2008    18,841,306    On or after December 9, 2008    NASDAQ Stock Market
Common stock, par value $.01   

Edward Jones

1887 Highway 190 West

DeRidder, LA 70634

        197    $3,623 as of December 5, 2008    18,841,306    On or after December 9, 2008    NASDAQ Stock Market

Potential persons who are to respond to the collection of information contained in this form are not

required to respond unless the form displays a currently valid OMB control number.

INSTRUCTIONS:

 

1.

  (a)   Name of issuer
  (b)   Issuer’s I.R.S. Identification Number
  (c)   Issuer’s S.E.C. file number, if any
 

(d)

(e)

 

Issuer’s address, including zip code

Issuer’s telephone number, including area code

2.

  (a)   Name of person for whose account the securities are to be sold
 

(b)

 

  Such person’s I.R.S. identification number, if such person is an entity
  (c)   Such person’s relationship to the issuer (e.g., officer, director, 10% stockholder, or member of immediate family of any of the foregoing)
  (d)   Such person’s address, including zip code
3.   (a)   Title of the class of securities to be sold
  (b)   Name and address of each broker through whom the securities are intended to be sold
  (c)   Number of shares or other units to be sold (if debt securities, give the aggregate face amount)
  (d)   Aggregate market value of the securities to be sold as of a specified date within 10 days prior to the filing of this notice
  (e)  

Number of shares or other units of the class outstanding, or if debt securities the face amount thereof outstanding, as shown by the most recent report or statement published by the issuer

Approximate date on which the securities are to be sold

  (f)  
  (g)   Name of each securities exchange, if any, on which the securities are intended to be sold


TABLE I—SECURITIES TO BE SOLD

Furnish the following information with respect to the acquisition of the securities to be sold

and with respect to the payment of all or any part of the purchase price or other consideration therefor:

 

Title of

the Class

 

Date you

Acquired

  Nature of Acquisition Transaction  

Name of Person from Whom Acquired

(If gift, also give date donor acquired)

  Amount of
Securities Acquired
  Date of
Payment
  Nature of
Payment
Common Stock, par value $.01   09/02/1997   Private purchase.   AMERISAFE, Inc.   197 shares   09/02/1997   Cash
Common Stock, par value $.01   11/17/2005
  Purchased in IPO.   AMERISAFE, Inc.   3,000 shares   11/17/2005   Cash
INSTRUCTIONS:   

1.      If the securities were purchased and full payment therefor was not made in cash at the time of purchase, explain in the table or in a note thereto the nature of the consideration given. If the consideration consisted of any note or other obligation, or if payment was made in installments describe the arrangement and state when the note or other obligation was discharged in full or the last installment paid.

  

2.      If within two years after the acquisition of the securities the person for whose account they are to be sold had any short positions, put or other option to dispose of securities referred to in paragraph (d)(3) of Rule 144, furnish full information with respect thereto.

 

 

 

TABLE II—SECURITIES SOLD DURING THE PAST 3 MONTHS

Furnish the following information as to all securities of the issuer sold during the past 3 months by the person for whose account the securities are to be sold.

 

Name and Address of Seller   Title of Securities Sold   Date of Sale   Amount of
Securities Sold
  Gross Proceeds
                 

REMARKS:

 

 

 

INSTRUCTIONS:

See the definition of “person” in paragraph (a) of Rule 144. Information is to be given not only as to the person for whose account the securities are to be sold but also as to all other persons included in that definition. In addition, information shall be given as to sales by all persons whose sales are required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the person filing this notice.

 

ATTENTION:

The person for whose account the securities to which this notice relates are to be sold hereby represents by signing this notice that he does not know any material adverse information in regard to the current and prospective operations of the Issuer of the securities to be sold which has not been publicly disclosed.

December 9, 2008

DATE OF NOTICE

 

/s/ C. Allen Bradley, Jr.

(SIGNATURE)

The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed.

Any copies not manually signed shall bear typed or printed signatures.

 

ATTENTION: Intentional misstatements or omission of facts constitute Federal Criminal Violations (See 18 U.S.C. 1001)