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