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
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1. Name and Address of Reporting Person*
McNulty Brian Patrick

(Last) (First) (Middle)
C/O MIRA PHARMACEUTICALS, INC.
900 WEST PLATT STREET, SUITE 200

(Street)
TAMPA FL 33606-2173

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/26/2023
3. Issuer Name and Ticker or Trading Symbol
MIRA PHARMACEUTICALS, INC. [ MIRA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
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)
Common Stock 10,000 D(1)
Common Stock 2,859,318 I By Trust(2)
Common Stock 660,000 I By Trust(3)
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
Common Stock (right to buy) 04/28/2023 04/28/2028 Common Stock 1,000,000 $5 I By Trust(2)
Explanation of Responses:
1. These securities are owned directly by Brian McNulty ("Mr. McNulty").
2. These securities are owned directly by the Bay Shore Trust (the "Trust"), a 10% owner of the Issuer, and indirectly by Mr. McNulty as trustee of the Trust. Mr. McNulty disclaims beneficial ownership of the reported securities because he is deemed to hold these securities only because of his role as Trustee and does not have any pecuniary interest in such securities.
3. These securities are owned directly by a trust and indirectly by Mr. McNulty as trustee of such trust. Mr. McNulty disclaims beneficial ownership of the reported securities because he is deemed to hold these securities only because of his role as Trustee and does not have any pecuniary interest in such securities.
/s/ Michelle Yanez, Attorney-in-Fact for Brian McNulty 10/12/2023
** 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.
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