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