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*
Yazbeck Daniel, Rida

(Last) (First) (Middle)
6335 FERRIS SQUARE, SUITE B

(Street)
SAN DIEGO CA 92121

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/30/2015
3. Issuer Name and Ticker or Trading Symbol
MyDx, Inc. [ MYDX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman of the Board and CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
05/11/2015
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 1,000,000 I By Self as Trustee for the Adriana Tomazelli Trust
Common Stock 1,000,000 I By Self as Trustee for the ARY Investment Trust
Common Stock 946,667 I By Self as Trustee for the Dr. O. Shaddad Trust
Common Stock 733,333 I By Self as Trustee for the Marcel Investment Trust
Common Stock 927,500 I By Self as Trustee for the One World Trust
Common Stock 3,875,000 I By Self as Trustee for Yazbeck Living Trust
Common Stock 1,000,000 I By Self as Trustee for Zoe Enterprises Trust
Common Stock 420,000 I YCIG, Inc.
Common Stock 10,000 D
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 Options (1) 07/11/2024 Common Stock 250,000 $0.08 D
Common Stock Options (2) 07/11/2024 Common Stock 250,000 $0.08 D
Explanation of Responses:
1. Options vest equally on a monthly basis over 12 months.
2. Options vest equally on a monthly basis over 24 months.
Remarks:
All shares of common stock and stock options were acquired pursuant to the closing of the MyDx, Inc. Merger Agreement dated April 9, 2015.
/s/ Daniel R. Yazbeck 06/25/2015
** 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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