Initial Statement of Beneficial Ownership (3)

Date : 08/28/2019 @ 9:57PM
Source : Edgar (US Regulatory)
Stock : Item 9 Labs Corporation (PK) (INLB)
Quote : 1.0  0.0 (0.00%) @ 2:30PM

Initial Statement of Beneficial Ownership (3)

FORM 3
        
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Poirier Andrew

2. Date of Event Requiring Statement (MM/DD/YYYY)
8/26/2019 

3. Issuer Name and Ticker or Trading Symbol

Item 9 Labs Corp. [INLB]

(Last)        (First)        (Middle)

1709 EAST BETHANY HOME ROAD

4. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                          ___X___ 10% Owner
_____ Officer (give title below)        _____ Other (specify below)

(Street)

PHOENIX, AZ 85016      

(City)              (State)              (Zip)
5. If Amendment, Date Original Filed(MM/DD/YYYY)

 

6. Individual or Joint/Group Filing(Check Applicable Line)

_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person


Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security
(Instr. 4)
2. Amount of Securities Beneficially Owned
(Instr. 4)
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
4. Nature of Indirect Beneficial Ownership
(Instr. 5)
Common 7978045 D  

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 4)
2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
4. Conversion or Exercise Price of Derivative Security5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
Date ExercisableExpiration DateTitleAmount or Number of Shares

Explanation of Responses:

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Poirier Andrew
1709 EAST BETHANY HOME ROAD
PHOENIX, AZ 85016

X


Signatures
Andrew Poirier8/28/2019
**Signature of Reporting PersonDate

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