UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Non-Qualified Stock Option | (1) | (1) | Common Stock | 24,053 | $ 0.263 | D | |
Series A-1 Convertible Preferred Stock | (2) | (2) | Common Stock | (2) | $ 1 | I | See footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fay Ford Byron C/O SOBR SAFE, INC 885 ARAPAHOE ROAD BOULDER,, CO 80302 |
X |
/s/ Ford Byron Fay | 06/22/2020 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The Reporting Person was granted an option on October 25, 2019, for 24,053 post reverse stock split shares of Common Stock pursuant to an engineering services agreement. The Options vest at the rate of 6,013.25 post reverse stock split shares quarterly commencing January 1, 2020. The Share Option expires October 24, 2024. |
(2) | The Reporting Person owns $25,000 of membership interests in Sobre Safe, LLC("SSLLC"), a special purpose entity formed to invest in the Series A-1 Preferred Stock of the Issuer. As a member of SSLLC the Reporting Person has a right to distributions from SSLLC, which may include distributions of the Issuer's Series A-1 Preferred Stock or the common stock of the Issuer (if the Series A-1 is converted to common stock). |