Annual Statement of Changes in Beneficial Ownership (5)
16 Giugno 2014 - 10:07PM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[ ]
Form 3 Holdings Reported
[
X
]
Form 4 Transactions Reported
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
KELLER JESSE
|
2. Issuer Name
and
Ticker or Trading Symbol
APPIPHANY TECHNOLOGIES HOLDINGS CORP [APHD]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Pres, CEO, CFO, Sec, Treasurer
|
(Last)
(First)
(Middle)
P.O. BOX 21101 ORCHARD PARK
|
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
4/30/2014
|
(Street)
KELOWNA, A1 V1Y 9N8
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security
(Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. Code
(Instr. 8)
|
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
|
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
|
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
|
Amount
|
(A) or (D)
|
Price
|
Common Stock
|
8/28/2013
|
|
J4
(1)
|
3000000
|
A
|
$30000
|
6420000
|
D
|
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 3)
|
2. Conversion or Exercise Price of Derivative Security
|
3. Trans. Date
|
3A. Deemed Execution Date, if any
|
4. Trans. 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
(MM/DD/YYYY)
|
7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
|
8. Price of Derivative Security
(Instr. 5)
|
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
|
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
|
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
|
(A)
|
(D)
|
Date Exercisable
|
Expiration Date
|
Title
|
Amount or Number of Shares
|
Explanation of Responses:
|
(
1)
|
On August 28, 2013, the Company entered into a debt settlement agreement with Jesse Keller, pursuant to which the Company issued 3,000,000 common shares to Mr. Keller to settle accrued compensation owing of $30,000.
|
Reporting Owners
|
Reporting Owner Name / Address
|
Relationships
|
Director
|
10% Owner
|
Officer
|
Other
|
KELLER JESSE
P.O. BOX 21101 ORCHARD PARK
KELOWNA, A1 V1Y 9N8
|
X
|
X
|
Pres, CEO, CFO, Sec, Treasurer
|
|
Signatures
|
/s/ Jesse Keller
|
|
6/16/2014
|
**
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 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 control number.
|
Grafico Azioni Apogee 21 (CE) (USOTC:APHD)
Storico
Da Nov 2024 a Dic 2024
Grafico Azioni Apogee 21 (CE) (USOTC:APHD)
Storico
Da Dic 2023 a Dic 2024
Notizie in Tempo Reale relative a Apogee 21 Holdings Inc (CE) (OTCMarkets): 0 articoli recenti
Più Appiphany Technologies Holdings Corp Articoli Notizie