Statement of Changes in Beneficial Ownership (4)
August 22 2022 - 6:01PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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Dockter A Scott |
2. Issuer Name and Ticker or Trading Symbol
PureBase Corp
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PUBC
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Executive Officer |
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(Last)
(First)
(Middle)
8631 HIGHWAY 124 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/22/2019 |
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(Street)
IONE, CA 95640
(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 | 3/22/2019 | 3/22/2019 | J(1) | | 6000000 | D | (1) | 38665932 | D | |
| Common stock | 6/26/2020 | 6/26/2020 | J(1) | | 6000000 | A | (1) | 44665932 | D | |
| Common stock | 8/24/2021 | 8/24/2021 | J(1) | | 1072137 | D | (1) | 43593795 | D | |
| Common stock | 8/24/2021 | 8/24/2021 | G | | 2500000 | D | (2) | 41093795 | D | |
| Common stock | 12/7/2021 | 12/7/2021 | J(1) | | 1150000 | D | (1) | 39943795 | D | |
| Common stock | 2/22/2022 | 2/22/2022 | J(1) | | 1400000 | D | (1) | 38543795 | D | |
| Common stock | 6/17/2022 | 6/17/2022 | J(1) | | 500000 | D | (1) | 38043795 | D | |
| Common stock | 8/10/2022 | 8/10/2022 | J(1) | | 1000000 | D | (1) | 37043795 | D | |
| Common stock | 9/5/2019 | 9/5/2019 | J(3) | | 60248484 | A | $0.09 | 60248484 | I | By Corporation |
| Common stock | 2/3/2020 | 2/3/2020 | J(3) | | 6290094 | A | $0.09 | 66538578 | I | By Corporation |
| Common stock | 7/7/2020 | 7/20/2020 | J(3) | | 6720905 | A | $0.16 | 73259483 | I | By Corporation |
| Common stock | 7/7/2022 | 7/7/2022 | J(3) | | 17020749 | A | $0.088 | 90280232 | I | By Corporation |
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 |
| Stock option (right to buy) | $0.38 | 10/6/2021 | 10/6/2021 | J (4) | | 116000000 | | (5) | 4/6/2028 | Common Stock | 116000000 (6) | $0.38 | 116000000 | I | By limited liability company |
| Explanation of Responses: |
| (1) | Represents shares paid to third parties as consideration for making loans to the Reporting Person. |
| (2) | Bona fide gift. |
| (3) | Represents shares held by US Mine Corporation, of which the Reporting Person is a 33% owner. The Reporting Person disclaims beneficial ownership as to 66% of such shares. |
| (4) | Option issued to US Mine Corp. as consideration for rights granted under a mineral extraction agreement with the Issuer. |
| (5) | 58,000,000 shares subject to the option were exercisable as of 4/6/22, 29,000,000 shares vest and become exercisable on 10/6/22 and 29,000,000 shares vest and become exercisable on 4/6/23. |
| (6) | Represents shares exercisable under an option held by US Mine LLC, of which the Reporting Person is a 33.3% owner. The Reporting Person disclaims beneficial ownership as to 66.6% of such shares. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Dockter A Scott
8631 HIGHWAY 124
IONE, CA 95640 | X | X | Chief Executive Officer |
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Signatures
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| /s/ A. Scott Dockter | | 8/22/2022 |
| **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. |
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