0001144204-15-055445.txt : 20150917 0001144204-15-055445.hdr.sgml : 20150917 20150917160105 ACCESSION NUMBER: 0001144204-15-055445 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: FAGENSON ROBERT B CENTRAL INDEX KEY: 0001215183 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32146 FILM NUMBER: 151112273 MAIL ADDRESS: STREET 1: FAGENSON & CO. INC STREET 2: 60 BROAD STREET CITY: NEW YORK STATE: NY ZIP: 10004 4 1 v420357_4.xml OWNERSHIP DOCUMENT X0306 4 2015-09-15 0 0000771999 DOCUMENT SECURITY SYSTEMS INC DSS 0001215183 FAGENSON ROBERT B C/O DOCUMENT SECURITY SYSTEMS, INC. 28 EAST MAIN STREET, SUITE 1525 ROCHESTER NY 14614 1 0 0 0 Common Stock 2015-09-15 4 P 0 454545 .22 A 1335321 D Warrant .40 2015-09-15 4 P 0 90909 A 2016-03-16 2020-03-16 Common Stock 90909 90909 D Does not include, as previously reported on Form 4, 100,000 shares of the Issuer's common stock ("Common Stock") owned by the Reporting Person's spouse, 50,000 shares of Common Stock owned by a trust for the benefit of Stephanie Fagenson, and 50,000 shares of Common Stock owned by a trust for the benefit of Jennifer Fagenson. Warrant issued at no additional cost in connection with the Reporting Person's purchase of 454,545 shares of Common Stock from the Issuer. /s/ Robert B. Fagenson 2015-09-17