Statement of Changes in Beneficial Ownership (4)
November 23 2020 - 5:04PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
Barbera Michael Vito |
2. Issuer Name and Ticker or Trading Symbol
BASANITE, INC.
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BASA
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
1423 SW 13TH DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/19/2020 |
(Street)
BOCA RATON, FL 33486
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 11/19/2020 | | X(1) | | 1000000 | A | $0.0375 | 6104717 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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 | 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 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) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Warrant | $0.0375 | 11/19/2020 | | X (1) | | | 1000000 | 11/1/2018 | 10/31/2023 | Common Stock | 1000000 | $0.075 (1) | 1000000 | D | |
Explanation of Responses: |
(1) | On November 19, 2020, the Reporting Person converted a portion of Common Stock Warrant dated November 1, 2018 (the "Warrant") for 1,000,000 shares of the Issuer's common stock at a per share exercise price of $0.0375, or an aggregate exercise price of $37,500. The Warrant had an initial exercise price of $0.075 and such $0.075 price shall continue to be the exercise price for the remaining 1,000,000 shares of common stock underlying the Warrant. All shares of common stock issued pursuant to the exercise are "restricted securities" as defined by the Securities Act of 1933, as amended. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Barbera Michael Vito 1423 SW 13TH DRIVE BOCA RATON, FL 33486 | X |
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Signatures
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/s/ Michael Vito Barbera | | 11/23/2020 |
**Signature of Reporting Person | Date |
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