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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1. Name and Address of Reporting Person*
LAWRENCE JEFFREY D

(Last) (First) (Middle)
30 FRANK LLOYD WRIGHT DR

(Street)
ANN ARBOR MI 48105

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/28/2015
3. Issuer Name and Ticker or Trading Symbol
DOMINOS PIZZA INC [ DPZ ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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, $0.01 par value 9,541.478(1)(2)(3)(4)(5)(6) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Option to Purchase Common Stock 07/18/2012 07/18/2017 Common Stock, $0.01 par value 10,800 10.06 D
Option to Purchase Common Stock 07/16/2012 07/16/2019 Common Stock, $0.01 par value 4,000 7.97 D
Option to Purchase Common Stock 07/18/2012 07/18/2017 Common Stock, $0.01 par value 2,700 10.06 D
Option to Purchase Common Stock 07/16/2013 07/16/2018 Common Stock, $0.01 par value 9,600 10.88 D
Option to Purchase Common Stock 07/16/2013 07/16/2018 Common Stock, $0.01 par value 4,000 10.88 D
Option to Purchase Common Stock 07/16/2013 07/16/2018 Common Stock, $0.01 par value 2,400 7.88 D
Option to Purchase Common Stock 07/16/2013 07/16/2018 Common Stock, $0.01 par value 1,000 7.88 D
Option to Purchase Common Stock 07/17/2017(7) 07/17/2023 Common Stock, $0.01 par value 1,470 63.05 D
Option to Purchase Common Stock 07/16/2018(8) 07/16/2024 Common Stock, $0.01 par value 2,630 73.04 D
Option to Purchase Common Stock 07/15/2019(9) 07/15/2025 Common Stock, $0.01 par value 2,060 118.54 D
Option to Purchase Common Stock 07/15/2019(9) 07/15/2025 Common Stock, $0.01 par value 9,070 118.54 D
Explanation of Responses:
1. Includes 823.345 shares acquired under the Domino's Employee Stock Payroll Deduction Plan.
2. Includes 890 shares of common stock representing two-fourths of an original grant of performance-based restricted stock that shall vest one-half on each of July 17, 2016 and July 17, 2017 if applicable performance conditions are achieved.
3. Includes 1,060 shares of common stock representing two-fourths of an original grant of performance-based restricted stock that shall vest one-half on each of February 27, 2016 and February 27, 2017 if applicable performance conditions are achieved.
4. Includes 1,133 shares of common stock representing three-fourths of an original grant of performance-based restricted stock that shall vest one-third on each of July 16, 2016, July 16, 2017 and July 16, 2018 if applicable performance conditions are achieved.
5. Includes 960 shares of common stock representing a grant of performance-based restricted stock that shall vest one-fourth on each of July 15, 2016, July 15, 2017, July 15, 2018 and July 15, 2019 if applicable performance conditions are achieved.
6. Includes 2,110 shares of common stock representing a grant of performance-based restricted stock that shall vest one-fourth on each of July 15, 2016, July 15, 2017, July 15, 2018 and July 15, 2019 if applicable performance conditions are achieved.
7. The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth vested on each of July 17, 2014 and July 17, 2015, and one-fourth shall vest on each of July 17, 2016 and July 17, 2017.
8. The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth vested on July 16, 2015, and one-fourth shall vest on each of July 16, 2016, July 16, 2017 and July 16, 2018.
9. The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth shall vest on each of July 15, 2016, July 15, 2017, July 15, 2018 and July 15, 2019.
Remarks:
/s/ Adam J. Gacek, attorney-in-fact 09/01/2015
** 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 by these present, that the undersigned hereby constitutes
and appoints Adam Gacek and Stacey Rodriguez, signing singly, the undersigned's
true and lawful attorney-in-fact to:
(1)        execute for and on behalf of the undersigned, in the undersigned's
capacity as an officer and/or director of Domino's Pizza, Inc. (the "Company"),
Forms 3, 4, and 5 in accordance with Section 16(a) of the Securities Exchange
Act of 1934 and the rules thereunder;
(2)        do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form 3, 4,
or 5, complete and execute any amendment or amendments thereto, and timely file
such form 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-fact's discretion.
  	The undersigned hereby grants to each 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-fact's 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 the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.
         This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 28th day of August, 2015.

/s/ Jeffrey D. Lawrence
JEFFREY D. LAWRENCE