# EDGAR Filing Document

**Accession Number:** 0000913960
**File Stem:** 0001213900-25-061149
**Filing Date:** 2025-7
**Character Count:** 20031
**Document Hash:** 099a7d37e6b5a251287a43fb1a58d60f
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001213900-25-061149.hdr.sgml**: 20250702

**ACCESSION NUMBER**: 0001213900-25-061149

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250630

**FILED AS OF DATE**: 20250702

**DATE AS OF CHANGE**: 20250702

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** STILWELL ASSOCIATES L P
- **CENTRAL INDEX KEY:** 0000913960

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35713
- **FILM NUMBER:** 251103269

**BUSINESS ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
- **BUSINESS PHONE:** 212-269-5800

**MAIL ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** STILWELL JOSEPH
- **CENTRAL INDEX KEY:** 0001113303

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35713
- **FILM NUMBER:** 251103274

**MAIL ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Stilwell Value LLC
- **CENTRAL INDEX KEY:** 0001397076

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35713
- **FILM NUMBER:** 251103273

**BUSINESS ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
- **BUSINESS PHONE:** 2122695800

**MAIL ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Stilwell Activist Investments, L.P.
- **CENTRAL INDEX KEY:** 0001573720

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35713
- **FILM NUMBER:** 251103272

**BUSINESS ADDRESS:**
- **STREET 1:** 111 BROADWAY
- **STREET 2:** 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
- **BUSINESS PHONE:** 212-269-5800

**MAIL ADDRESS:**
- **STREET 1:** 111 BROADWAY
- **STREET 2:** 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Stilwell Value Partners VII, L.P.
- **CENTRAL INDEX KEY:** 0001555931

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35713
- **FILM NUMBER:** 251103270

**BUSINESS ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
- **BUSINESS PHONE:** 212-269-5800

**MAIL ADDRESS:**
- **STREET 1:** 111 BROADWAY, 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Stilwell Activist Fund, L.P.
- **CENTRAL INDEX KEY:** 0001564452

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-35713
- **FILM NUMBER:** 251103271

**BUSINESS ADDRESS:**
- **STREET 1:** 111 BROADWAY
- **STREET 2:** 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
- **BUSINESS PHONE:** 212-269-5800

**MAIL ADDRESS:**
- **STREET 1:** 111 BROADWAY
- **STREET 2:** 12TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10006
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Wheeler Real Estate Investment Trust, Inc.
- **CENTRAL INDEX KEY:** 0001527541
- **STANDARD INDUSTRIAL CLASSIFICATION:** REAL ESTATE INVESTMENT TRUSTS [6798]
- **ORGANIZATION NAME:** 05 Real Estate & Construction
- **EIN:** 452681082
- **STATE OF INCORPORATION:** MD
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** RIVERSEDGE NORTH
- **STREET 2:** 2529 VIRGINIA BEACH BLVD., SUITE 200
- **CITY:** VIRGINIA BEACH
- **STATE:** VA
- **ZIP:** 23452
- **BUSINESS PHONE:** 757-627-9088

**MAIL ADDRESS:**
- **STREET 1:** RIVERSEDGE NORTH
- **STREET 2:** 2529 VIRGINIA BEACH BLVD., SUITE 200
- **CITY:** VIRGINIA BEACH
- **STATE:** VA
- **ZIP:** 23452

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>STILWELL JOSEPH<br><sub>(Last) (First) (Middle)</sub><br>200 CALLE DEL SANTO CRISTO<br><sub>(Street)</sub><br>SAN JUAN, PR 00901<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-06-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Wheeler Real Estate Investment Trust, Inc. [ WHLR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Stilwell Value LLC<br><sub>(Last) (First) (Middle)</sub><br>111 BROADWAY,12TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10006<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-06-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Wheeler Real Estate Investment Trust, Inc. [ WHLR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Stilwell Activist Investments, L.P.<br><sub>(Last) (First) (Middle)</sub><br>111 BROADWAY,12TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10006<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-06-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Wheeler Real Estate Investment Trust, Inc. [ WHLR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Stilwell Activist Fund, L.P.<br><sub>(Last) (First) (Middle)</sub><br>111 BROADWAY,12TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10006<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-06-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Wheeler Real Estate Investment Trust, Inc. [ WHLR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Stilwell Value Partners VII, L.P.<br><sub>(Last) (First) (Middle)</sub><br>111 BROADWAY,12TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10006<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-06-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Wheeler Real Estate Investment Trust, Inc. [ WHLR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>STILWELL ASSOCIATES L P<br><sub>(Last) (First) (Middle)</sub><br>111 BROADWAY,12TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10006<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-06-30 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Wheeler Real Estate Investment Trust, Inc. [ WHLR ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock |  |  |  |  |  |  |  | 405809 | I | See footnote<sup>(1)</sup> |
| Common Stock |  |  |  |  |  |  |  | 42598 | I | See footnote<sup>(2)</sup> |
| Common Stock |  |  |  |  |  |  |  | 88403 | I | See footnote<sup>(3)</sup> |
| Common Stock |  |  |  |  |  |  |  | 806 | I | See footnote<sup>(4)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 7.00% Subordinated Convertible Notes due 2031 | 2.82<sup>(5)</sup> |  |  |  |  |  |  | <sup>(5)</sup> | 2031-12-31 | Common Stock | 6086228<sup>(5)(6)</sup> |  |  | I | See footnote<sup>(1)</sup> |
| 7.00% Subordinated Convertible Notes due 2031 | 2.82<sup>(5)</sup> |  |  |  |  |  |  | <sup>(5)</sup> | 2031-12-31 | Common Stock | 888497<sup>(5)(6)</sup> |  |  | I | See footnote<sup>(2)</sup> |
| 7.00% Subordinated Convertible Notes due 2031 | 2.82<sup>(5)</sup> |  |  |  |  |  |  | <sup>(5)</sup> | 2031-12-31 | Common Stock | 1374785<sup>(5)(6)</sup> |  |  | I | See footnote<sup>(3)</sup> |
| 7.00% Subordinated Convertible Notes due 2031 | 2.82<sup>(5)</sup> |  |  |  |  |  |  | <sup>(5)</sup> | 2031-12-31 | Common Stock | 85082<sup>(5)(6)</sup> |  |  | I | See footnote<sup>(4)</sup> |
| Series D Cumulative Convertible Preferred Stock | 17095680<sup>(8)</sup> | 2025-06-30 |  | J |  | 34467<sup>(7)</sup> |  | <sup>(8)</sup> | <sup>(8)</sup> | Common Stock | 0<sup>(8)</sup> | <sup>(9)</sup> | 103773 | I | See footnote<sup>(1)</sup> |
| Series D Cumulative Convertible Preferred Stock | 17095680<sup>(8)</sup> | 2025-06-30 |  | J |  | 4943<sup>(7)</sup> |  | <sup>(8)</sup> | <sup>(8)</sup> | Common Stock | 0<sup>(8)</sup> | <sup>(9)</sup> | 14887 | I | See footnote<sup>(2)</sup> |
| Series D Cumulative Convertible Preferred Stock | 17095680<sup>(8)</sup> | 2025-06-30 |  | J |  | 7769<sup>(7)</sup> |  | <sup>(8)</sup> | <sup>(8)</sup> | Common Stock | 0<sup>(8)</sup> | <sup>(9)</sup> | 20452 | I | See footnote<sup>(3)</sup> |
| Series D Cumulative Convertible Preferred Stock | 17095680<sup>(8)</sup> | 2025-06-30 |  | J |  | 452<sup>(7)</sup> |  | <sup>(8)</sup> | <sup>(8)</sup> | Common Stock | 0<sup>(8)</sup> | <sup>(9)</sup> | 1361 | I | See footnote<sup>(4)</sup> |
| Series B Convertible Preferred Stock | 40320000<sup>(10)</sup> |  |  |  |  |  |  | <sup>(10)</sup> | <sup>(10)</sup> | Common Stock | 0<sup>(10)</sup> |  | 578645 | I | See footnote<sup>(1)</sup> |
| Series B Convertible Preferred Stock | 40320000<sup>(10)</sup> |  |  |  |  |  |  | <sup>(10)</sup> | <sup>(10)</sup> | Common Stock | 0<sup>(10)</sup> |  | 83488 | I | See footnote<sup>(2)</sup> |
| Series B Convertible Preferred Stock | 40320000<sup>(10)</sup> |  |  |  |  |  |  | <sup>(10)</sup> | <sup>(10)</sup> | Common Stock | 0<sup>(10)</sup> |  | 131199 | I | See footnote<sup>(3)</sup> |

---

### Footnotes:

(1) These securities are owned directly by Stilwell Activist Investments, L.P. ("SAI") and indirectly by Joseph Stilwell in his capacity as the managing member and owner of Stilwell Value LLC ("Value"), which is the general partner of SAI. Joseph Stilwell disclaims beneficial ownership of all shares reported as owned indirectly except to the extent of his pecuniary interest therein.

(2) These securities are owned directly by Stilwell Activist Fund, L.P. ("SAF") and indirectly by Joseph Stilwell in his capacity as the managing member and owner of Value, which is the general partner of SAF. Joseph Stilwell disclaims beneficial ownership of all shares reported as owned indirectly except to the extent of his pecuniary interest therein.

(3) These securities are owned directly by Stilwell Value Partners VII, L.P. ("SVP VII") and indirectly by Joseph Stilwell in his capacity as the managing member and owner of Value, which is the general partner of SVP VII. Joseph Stilwell disclaims beneficial ownership of all shares reported as owned indirectly except to the extent of his pecuniary interest therein.

(4) These securities are owned directly by Stilwell Associates, L.P. ("SA") and indirectly by Joseph Stilwell in his capacity as the managing member and owner of Value, which is the general partner of SA. Joseph Stilwell disclaims beneficial ownership of all shares reported as owned indirectly except to the extent of his pecuniary interest therein.

(5) The Issuer's 7.00% Subordinated Convertible Notes due 2031 (the "Notes") are convertible, in whole or in part, at any time, at the option of the holders thereof, into shares of the Issuer's common stock at a conversion price of $2.819312 per share (8.867413 common shares for each $25.00 of principal amount of the Notes being converted).

(6) Interest on the Notes may be payable, at the Issuer's election, in cash, in shares of the Issuer's Series B Convertible Preferred Stock ("Series B Preferred Stock") or in shares of the Issuer's Series D Cumulative Convertible Preferred Stock ("Series D Preferred Stock"), in each case as set forth in the Notes. The number of shares of the Issuer's common stock indicated in the Table is based on the outstanding principal amount of the Notes held by the Reporting Person.

(7) As disclosed in the Issuer's Form 8-K filed with the Securities and Exchange Commission on May 22, 2025, the Issuer determined that interest on the Notes payable on June 30, 2025, would be paid in the form of Series D Preferred Stock. On June 30, 2025, the Issuer issued shares of Series D Preferred Stock to the Reporting Person as payment of interest with respect to the Notes, in accordance with the terms thereof and of the Indenture among the Issuer and Wilmington Savings Fund Society, FSB, as Trustee, governing the terms of the Notes (the "Indenture").

(8) Each share of Series D Preferred Stock is convertible, in whole or in part, at any time, at the option of the holders thereof, into 001 shares of the Issuer's common stock (a conversion price of $17,095,680 per share of common stock). Series D Preferred Stock has no expiration date.

(9) In accordance with the terms of the Indenture, the number of shares of Series D Preferred Stock paid as interest on the Notes on June 30, 2025 was determined based on a per share value of $18.58379, calculated as the product of (x) the average of the per share volume-weighted average prices for Series D Preferred Stock for the 15 consecutive trading days ending on the third business day immediately preceding the interest payment date, and (y) 0.55.

(10) Each share of Series B Preferred Stock is convertible, in whole or in part, at any time, at the option of the holders thereof, into 0006 shares of the Issuer's common stock (a conversion price of $40,320,000 per share of common stock). Series B Preferred Stock has no expiration date.

**Signature:** /s/ Joseph Stilwell  
**Date:** 2025-07-02

**Signature:** /s/ Joseph Stilwell as authorized agent for Stilwell Value LLC  
**Date:** 2025-07-02

**Signature:** /s/ Joseph Stilwell as authorized agent for Stilwell Activist Investments, L.P.  
**Date:** 2025-07-02

**Signature:** /s/ Joseph Stilwell as authorized agent for Stilwell Activist Fund, L.P.  
**Date:** 2025-07-02

**Signature:** /s/ Joseph Stilwell as authorized agent for Stilwell Value Partners VII, L.P.  
**Date:** 2025-07-02

**Signature:** /s/ Joseph Stilwell as authorized agent for Stilwell Associates, L.P.  
**Date:** 2025-07-02

### Remarks:

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 4 (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.**