0001493152-17-000479.txt : 20170113
0001493152-17-000479.hdr.sgml : 20170113
20170113161100
ACCESSION NUMBER: 0001493152-17-000479
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170112
FILED AS OF DATE: 20170113
DATE AS OF CHANGE: 20170113
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: Bzdick Robert B.
CENTRAL INDEX KEY: 0001484889
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-32146
FILM NUMBER: 17527874
MAIL ADDRESS:
STREET 1: 28 MAIN STREET EAST
STREET 2: SUITE 1525
CITY: ROCHESTER
STATE: NY
ZIP: 14614
4
1
form4.xml
X0306
4
2017-01-12
0
0000771999
DOCUMENT SECURITY SYSTEMS INC
DSS
0001484889
Bzdick Robert B.
935 RACOON RUN
VICTOR
NY
14564
1
1
0
0
President
Common Stock
2017-01-12
4
A
0
50000
A
304996
D
Issued to Reporting Person From Issuer's 2013 Employee, Director and Consultant Equity Incentive Plan for services previously provided to the Issuer.
Common Stock grant will vest on May 17, 2017.
Amount reflects a 1-for-4 reverse stock split which was affected by the Issuer on August 26, 2016.
/s/ Robert B. Bzdick
2017-01-13