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, Section 17(a) of the Public Utility Holding Company Act of 1935 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 | ||||
Common Stock Warrant (1) | 08/16/2018 | 08/16/2023 | Common Stock | 1,000,000 | $ 0.1235 | D | Â |
Common Stock Warrant (2) | 09/24/2018 | 09/24/2023 | Common Stock | 1,500,000 | $ 0.1235 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Anderson David Lawrence 2688 NW 29TH TERRACE BUILDING 13 OAKLAND PARK, FL 33311 |
 |  |  Chief Executive Officer |  |
/s/ Dave L. Anderson | 12/12/2018 | |
**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) | On 8/16/2018, Mr. Anderson was issued a warrant to purchase 1,000,000 shares of PayMeOn, Inc. common stock in conjunction with being appointed the Company's chief executive officer. |
(2) | On 9/24/18, Mr. Anderson was issued a warrant to purchase 1,500,000 shares of PayMeOn, Inc. common stock in conjunction with duties associated with, and above the pale and initial contractual agreement as chief executive officer. |