SEC Form 3
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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Soria Mercedes

(Last) (First) (Middle)
C/O KNIGHTSCOPE, INC.
1070 TERRA BELLA AVENUE

(Street)
MOUNTAIN VIEW CA 94043

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/27/2022
3. Issuer Name and Ticker or Trading Symbol
Knightscope, Inc. [ KSCP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Intelligence Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
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)
Class B Common Stock 7,000,000 I By husband(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Stock Option (Right to Buy) (2) 04/20/2024 Class B Common Stock 113,000 $0.16 D
Stock Option (Right to Buy) (2) 11/17/2026 Class B Common Stock 187,000 $0.6 D
Stock Option (Right to Buy) (3) 04/21/2028 Class B Common Stock 200,000 $1.26 D
Stock Option (Right to Buy) (4) 05/09/2029 Class A Common Stock 500,000 $1.24 D
Stock Option (Right to Buy) (3) 02/26/2030 Class A Common Stock 100,000 $0.91 D
Stock Option (Right to Buy) (3) 06/23/2030 Class A Common Stock 35,000 $0.91 D
Explanation of Responses:
1. The shares are directly held by William Santana Li, husband of the reporting person.
2. The stock options are currently exercisable.
3. The stock options vest and become exercisable as to 25% of the option shares after 12 months, and vest as to the remaining shares in equal monthly installments over the subsequent 48 months, subject to continuous service with the issuer as of each vesting date.
4. The stock options vest and become exercisable in 48 equal monthly installments, subject to continuous service with the issuer as of each vesting date.
Remarks:
/s/ Peter Weinberg, Attorney-in-Fact 02/01/2022
** 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 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.