Initial Statement of Beneficial Ownership (3)
06 Giugno 2018 - 12:18AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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
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SHAW MICHAEL
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/3/2018
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3. Issuer Name
and
Ticker or Trading Symbol
VOLT INFORMATION SCIENCES, INC. [VISI]
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(Last)
(First)
(Middle)
167 HILLCREST ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
BERKELEY, CA 94705
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, $0.01 par value
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119852
(1)
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D
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Common Stock, $0.01 par value
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750872
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I
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Co-trustee
(1)
(4)
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Common Stock, $0.01 par value
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1052583
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I
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Co-trustee
(2)
(3)
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Common Stock, $0.01 par value
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1401547
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I
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Co-trustee
(4)
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Common Stock, $0.01 par value
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12750
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I
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Officer and director of corporate owner
(3)
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Common Stock, $0.01 par value
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7650
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I
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Beneficiary of 401K of another
(5)
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Common Stock, $0.01 par value
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798
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I
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Beneficiary of ESOP plan of another
(6)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Emplpoyee Stock Option (Right to Buy)
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(7)
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4/6/2019
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Common Stock, $0.01 par value
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8000
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$6.39
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I
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Co-trustee
(4)
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Explanation of Responses:
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(1)
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Jointly owned with Reporting Person's spouse.
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(2)
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Reporting Person is a co-trustee of a trust for the benefit of another.
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(3)
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Reporting Person disclaims any beneficial ownership of these shares. Reporting Person has no current pecuniary interest in these shares except as a co-trustee or officer or director.
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(4)
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Reporting Person is a co-trustee and beneficiary of this trust.
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(5)
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Reporting Person is the beneficiary of on-third of the holdings of a 401K of another. Upon the death of the Reporting Person's father on May 3, 2018, Reporting Person has the right to acquire these shares within 60 days.
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(6)
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Reporting Person is the beneficiary of one-third of the holdings of an ESOP of another. Upon the death of Reporting Person's father on May 3, 2018, Reporting Person has the right to acquire these shares within 60 days.
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(7)
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Option vests in 20% annual installments, on a cumulative basis, commencing 4/7/2010, one year after the date of the original grant of the option.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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SHAW MICHAEL
167 HILLCREST ROAD
BERKELEY, CA 94705
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X
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Signatures
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Michael Shaw
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6/5/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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