# EDGAR Filing Document

**Accession Number:** 0001969416
**File Stem:** 0001209191-23-021578
**Filing Date:** 2023-3
**Character Count:** 8349
**Document Hash:** 9318adcd416a49ec3047a962d8cb7b65
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-021578.hdr.sgml**: 20230330

**ACCESSION NUMBER**: 0001209191-23-021578

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20230329

**FILED AS OF DATE**: 20230330

**DATE AS OF CHANGE**: 20230330

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Sellig Thomas
- **CENTRAL INDEX KEY:** 0001969416

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 033-80623
- **FILM NUMBER:** 23777901

**MAIL ADDRESS:**
- **STREET 1:** 22722 29TH DR SE
- **STREET 2:** SUITE 100
- **CITY:** BOTHELL
- **STATE:** WA
- **ZIP:** 98021
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** ACHIEVE LIFE SCIENCES, INC.
- **CENTRAL INDEX KEY:** 0000949858
- **STANDARD INDUSTRIAL CLASSIFICATION:** IN VITRO & IN VIVO DIAGNOSTIC SUBSTANCES [2835]
- **IRS NUMBER:** 954343413
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 22722 29TH DR. SE
- **STREET 2:** SUITE 100
- **CITY:** SEATTLE
- **STATE:** WA
- **ZIP:** 98021
- **BUSINESS PHONE:** 425-686-1500

**MAIL ADDRESS:**
- **STREET 1:** 22722 29TH DR. SE
- **STREET 2:** SUITE 100
- **CITY:** SEATTLE
- **STATE:** WA
- **ZIP:** 98021

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** ONCOGENEX PHARMACEUTICALS, INC.
- **DATE OF NAME CHANGE:** 20080821

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** SONUS PHARMACEUTICALS INC
- **DATE OF NAME CHANGE:** 19950825

## Ex-24

```

POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and appoints
Sandra Thomson, the undersigneds true and lawful attorney in-fact to:

(1) execute for and on behalf of the undersigned, in the undersigneds capacity
as an officer and/or director of Achieve Life Sciences, Inc. (the "Company"),
Forms 3, 4 and 5 (including amendments thereto) in accordance with Section 16(a)
of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and the
rules and regulations thereunder and a Form ID, Uniform Application for Access
Codes to File on Edgar (collectively, "Forms");

(2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete, execute and timely file any and all
such Forms with the United States Securities and Exchange Commission and any
stock exchange or similar authority; and

(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of 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 such
attorney-in-facts discretion.

The undersigned hereby grants to such attorney-in-fact full power and authority
to do and perform any and every act and thing whatsoever requisite, necessary or
proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-fact, or such
attorney-in-facts substitute or 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 such attorney-in-fact, in serving in
such capacity at the request of the undersigned, is not assuming, nor is the
Company assuming, any of the undersigneds responsibilities to comply with
Section 16 of the Exchange Act.

The undersigned agrees that each such attorney-in-fact herein may rely entirely
on information furnished orally or in writing by the undersigned to such
attorney-in-fact.  The undersigned also agrees to indemnify and hold harmless
the Company and such attorney-in-fact against any losses, claims, damages or
liabilities (or actions 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 such attorney-in fact for purposes of executing,
acknowledging, delivering or filing such Forms and agrees to reimburse the
Company and such attorney-in-fact for any legal or other expenses reasonably
incurred in connection with investigating or defending against any such loss,
claim, damage, liability or action.
This Power of Attorney supersedes any power of attorney previously executed by
the undersigned regarding the purposes outlined in the first paragraph hereof
("Prior Powers of Attorney"), and the authority of the attorney-in-fact named in
any Prior Powers of Attorney is hereby revoked.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file any such Forms with respect to the
undersigneds holdings of and transactions in securities issued by the Company,
unless earlier (a) revoked by the undersigned in a signed writing delivered to
such attorney-in-fact or (b) superseded by a new power of attorney regarding the
purposes outlined in the first paragraph hereof dated as of a later date.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of March 7, 2023.
Thomas Sellig

```

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

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Sellig Thomas<br><sub>(Last) (First) (Middle)</sub><br>22722 29TH DR SE<br>SUITE 100<br><sub>(Street)</sub><br>BOTHELL, WA 98021<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>ACHIEVE LIFE SCIENCES, INC. [ ACHV ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-03-29 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director   [ ] 10% Owner<br>[ ] Officer (give title below)   [ ] Other (specify below)<br>_ _ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| No securities are beneficially owned | 0 | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |

---

**Signature:** Sandra Thomson attorney-in-fact for Thomas Sellig  
**Date:** 2023-03-30

### 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.**