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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Convertible Note (1) | $ 0.07 | 04/04/2016 | A | $ 291,270.77 | 04/04/2016 | 08/04/2017 | Common | 1,248,303 | $ 0.07 | $ 291,270.77 | D | ||||
Convertible Note (2) | $ 0.07 | 04/04/2016 | A | $ 121,875.01 | 04/04/2016 | 08/04/2017 | Common | 1,741,072 | $ 0.07 | $ 121,875.01 | D | ||||
Warrants | $ 0.07 | 04/04/2016 | A | 2,080,505 | 04/04/2016 | 04/04/2019 | Common | 2,080,505 | $ 0.07 | 2,080,505 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
CUTAIA RORY J. 901 HANCOCK AVENUE, UNITE 308 WEST HOLLYWOOD, CA 90069 |
X | X | CEO |
/s/ Rory J. Cutaia | 05/19/2016 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Secured convertible note in the amount of $291,270.77 which represents additional sums that Mr. Cutaia advanced to bBooth, Inc. during the period from December 2015 to March 31, 2016. The note bears interest at the rate of 12% per annum compounded annually. Mr. Cutaia has the option to convert 30% of the note into shares of common stock at a price of $0.07 per share. |
(2) | Unsecured convertible note in the amount of $121,875.01 which represents the amount of accrued but unpaid salary owned for the period from December 2015 to March 31, 2016. The note bears interest at the rate of 12% per annum compounded annually. Mr. Cutaia has the option to convert 30% of the note into shares of common stock at a price of $0.07 per share. |