0001185185-17-000861.txt : 20170407
0001185185-17-000861.hdr.sgml : 20170407
20170407133512
ACCESSION NUMBER: 0001185185-17-000861
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170403
FILED AS OF DATE: 20170407
DATE AS OF CHANGE: 20170407
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: MEDIZONE INTERNATIONAL INC
CENTRAL INDEX KEY: 0000753772
STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-DRUGS PROPRIETARIES & DRUGGISTS' SUNDRIES [5122]
IRS NUMBER: 870412648
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 4000 BRIDGEWAY
STREET 2: SUITE 401
CITY: SAUSALITO
STATE: CA
ZIP: 94965
BUSINESS PHONE: (415) 331-0303
MAIL ADDRESS:
STREET 1: 4000 BRIDGEWAY
STREET 2: SUITE 401
CITY: SAUSALITO
STATE: CA
ZIP: 94965
FORMER COMPANY:
FORMER CONFORMED NAME: MADISON FUNDING INC
DATE OF NAME CHANGE: 19860413
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Montgomery Bobby Dwayne
CENTRAL INDEX KEY: 0001487585
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 002-93277-D
FILM NUMBER: 17748833
MAIL ADDRESS:
STREET 1: 110 HORIZON DRIVE
STREET 2: STE 230
CITY: RALEIGH
STATE: NC
ZIP: 27615
4
1
form4-montgomery040317.xml
OWNERSHIP DOCUMENT
X0306
4
2017-04-03
0
0000753772
MEDIZONE INTERNATIONAL INC
MZEI
0001487585
Montgomery Bobby Dwayne
6127 ORCHARD PARK DRIVE
FRISCO
TX
75034
1
0
0
0
Option to Purchase Common Stock
0.10
2017-04-03
4
A
0
500000
0.10
A
2017-04-03
2027-04-02
Common Stock
500000
500000
D
250,000 options vest upon appointment to the Board of Directors with the remaining 250,000 options vesting upon commercial placement of AsepticSure in the U.S. market.
/s/ Dwayne Montgomery
2017-04-07