0001445866-17-001447.txt : 20171017
0001445866-17-001447.hdr.sgml : 20171017
20171017162434
ACCESSION NUMBER: 0001445866-17-001447
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171006
FILED AS OF DATE: 20171017
DATE AS OF CHANGE: 20171017
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gray James Polin
CENTRAL INDEX KEY: 0001621404
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53571
FILM NUMBER: 171140935
MAIL ADDRESS:
STREET 1: 2531 CRESTVIEW DRIVE
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92663
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Cannabis Sativa, Inc.
CENTRAL INDEX KEY: 0001360442
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PERSONAL SERVICES [7200]
IRS NUMBER: 201898270
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1646 W. PIONEER BLVD.
STREET 2: SUITE 120
CITY: MESQUITE
STATE: NV
ZIP: 89027
BUSINESS PHONE: 702-346-3906
MAIL ADDRESS:
STREET 1: 1646 W. PIONEER BLVD.
STREET 2: SUITE 120
CITY: MESQUITE
STATE: NV
ZIP: 89027
FORMER COMPANY:
FORMER CONFORMED NAME: Ultra Sun Corp
DATE OF NAME CHANGE: 20060424
4
1
form4.xml
OWNERSHIP DOCUMENT
X0306
4
2017-10-06
1
0001360442
Cannabis Sativa, Inc.
CBDS
0001621404
Gray James Polin
2531 CRESTVIEW DRIVE
NEWPORT BEACH
CA
92663
0
0
0
1
Former Director
Common Stock
2017-10-06
4
A
0
5000
0
A
74144
D
Fully vested shares issued for services through 09/30/17. Mr. Gray resigned on September 30, 2017.
/s/ Jim Gray
2017-10-17