0001493152-16-013620.txt : 20160927
0001493152-16-013620.hdr.sgml : 20160927
20160927175422
ACCESSION NUMBER: 0001493152-16-013620
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160923
FILED AS OF DATE: 20160927
DATE AS OF CHANGE: 20160927
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: 200 CANAL VIEW BOULEVARD
STREET 2: SUITE 300
CITY: ROCHESTER
STATE: NY
ZIP: 14623
BUSINESS PHONE: 585 232 1500
MAIL ADDRESS:
STREET 1: 200 CANAL VIEW BOULEVARD
STREET 2: SUITE 300
CITY: ROCHESTER
STATE: NY
ZIP: 14623
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: 161905352
MAIL ADDRESS:
STREET 1: FAGENSON & CO. INC
STREET 2: 60 BROAD STREET
CITY: NEW YORK
STATE: NY
ZIP: 10004
4
1
form4.xml
X0306
4
2016-09-23
0
0000771999
DOCUMENT SECURITY SYSTEMS INC
DSS
0001215183
FAGENSON ROBERT B
C/O DOCUMENT SECURITY SYSTEMS, INC.
200 CANAL VIEW BLVD, SUITE 300
ROCHESTER
NY
14623
1
0
0
0
Common Stock
2016-09-23
4
P
0
7100
0.61
A
290931
D
Common Stock
2016-09-26
4
P
0
1025
0.61
A
291956
D
Common Stock
50000
I
See Footnote
Amounts reflect a 1-for-4 reverse stock split which was affected by DSS on August 26, 2016.
Consists of 25,000 shares held by Mr. Fagenson's wife, and an aggregate of 25,000 shares held in trusts for Mr. Fagenson's two adult children, of which Mr. Fagenson is trustee. Mr. Fagenson disclaims beneficial ownership of these 50,000 shares.
/s/ Robert B. Fagenson
2016-09-27