0001144204-15-055444.txt : 20150917 0001144204-15-055444.hdr.sgml : 20150917 20150917160042 ACCESSION NUMBER: 0001144204-15-055444 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150915 FILED AS OF DATE: 20150917 DATE AS OF CHANGE: 20150917 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DOCUMENT SECURITY SYSTEMS INC CENTRAL INDEX KEY: 0000771999 STANDARD INDUSTRIAL CLASSIFICATION: PAPERBOARD CONTAINERS & BOXES [2650] IRS NUMBER: 161229730 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 36 WEST MAIN ST STREET 2: SUITE 710 CITY: ROCHESTER STATE: NY ZIP: 14614 BUSINESS PHONE: 585 232 1500 MAIL ADDRESS: STREET 1: 36 W MAIN ST STREET 2: SUITE 710 CITY: ROCHESTER STATE: NY ZIP: 14614 FORMER COMPANY: FORMER CONFORMED NAME: NEW SKY COMMUNICATIONS INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: THOROUGHBREDS USA INC DATE OF NAME CHANGE: 19861118 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bzdick Robert B. CENTRAL INDEX KEY: 0001484889 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32146 FILM NUMBER: 151112272 MAIL ADDRESS: STREET 1: 28 MAIN STREET EAST STREET 2: SUITE 1525 CITY: ROCHESTER STATE: NY ZIP: 14614 4 1 v420356_4.xml OWNERSHIP DOCUMENT X0306 4 2015-09-15 0 0000771999 DOCUMENT SECURITY SYSTEMS INC DSS 0001484889 Bzdick Robert B. 935 RACCOON RUN VICTOR NY 14564 1 1 0 0 President Common Stock 2015-09-15 4 P 0 454545 .22 A 1019982 D Warrant .40 2015-09-15 4 P 0 90909 A 2016-03-16 2020-03-16 common stock 90909 90909 D Warrant issued at no additional cost in connection with the Reporting Person's purchase of 454,545 shares of common stock from the Issurer. /s/Robert Bzdick 2015-09-17