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