0001493152-19-011057.txt : 20190724 0001493152-19-011057.hdr.sgml : 20190724 20190724180134 ACCESSION NUMBER: 0001493152-19-011057 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190723 FILED AS OF DATE: 20190724 DATE AS OF CHANGE: 20190724 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chan Heng Fai Ambrose CENTRAL INDEX KEY: 0001261725 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32146 FILM NUMBER: 19971951 MAIL ADDRESS: STREET 1: 2601 INSLAND PLACE TOWER STREET 2: 510 KINGS RD N POINT CITY: HONG KONG STATE: K3 ZIP: 999999999 FORMER NAME: FORMER CONFORMED NAME: CHAN FAI DATE OF NAME CHANGE: 20030828 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 4 1 ownership.xml X0306 4 2019-07-23 0 0000771999 DOCUMENT SECURITY SYSTEMS INC DSS 0001261725 Chan Heng Fai Ambrose C/O DOCUMENT SECURITY SYSTEMS, INC. 200 CANAL VIEW BLVD., SUITE 300 ROCHESTER NY 14623 1 0 1 0 Common Stock 2019-07-23 4 A 0 74770 0 A 2077682 D Represents a restricted stock grant awarded to the Reporting Person by the Issuer pursuant to the Company's 2013 Employee, Director and Consultants Equity Incentive Plan in consideration for the Reporting Person's services as Executive Chairman of the Issuer and Executive Chairman and Chief Executive Officer of the Issuer's subsidiary. /s/ Heng Fai Ambrose Chan 2019-07-24