FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 12/10/2009 |
3. Issuer Name and Ticker or Trading Symbol
Ruby Creek Resources, Inc. [ RBYC ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 600,000 | D | |
Common Stock | 80,000 | I | By Booha Family Partners I(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant (right to buy) | (2) | 07/15/2014 | Common Stock | 900,000 | $0.05 | D | |
Warrant (right to buy) | 07/20/2009 | 07/20/2014 | Common Stock | 100,000 | $0.05 | D | |
Convertible Note | 11/27/2010(3) | 11/27/2010 | Common Stock | 1,000,000 | $0.05 | I | By Booha Family Partners I(1) |
Warrant (right to buy) | (4) | 11/27/2012 | Common Stock | 1,000,000 | $0.05 | I | By Booha Family Partners I |
Warrant (right to buy) | 12/22/2009 | 12/22/2011 | Common Stock | 40,000 | $0.125 | I | By Booha Family Partners I |
Warrant (right to buy) | (4) | 12/22/2011 | Common Stock | 300,000 | $0.25 | I | By Booha Family Partners I |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. David Bukzin is the managing general partner of the general partnership that owns the reported securities. Mr. Bukzin disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that he is the beneficial owner of such securities for the purposes of Section 16 or for any other purposes. |
2. Warrant vests 25% every three months from date of issuance. |
3. The Convertible Note is exercisable only upon maturity of the note at the option of the holder. |
4. The exercise of the warrant is prohibited if the holder and its affiliates together benefically own more than 9.999% of the Issuer's outstanding common stock. Such prohibition may be waived by the holder upon 61 days prior notice to the Issuer. |
David Bukzin (By Mark F. Coldwell, by Power of Attorney) | 01/25/2010 | |
** 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 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). | ||
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 Number. |