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