Statement of Changes in Beneficial Ownership (4)
October 04 2021 - 7:31PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
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1. Name and Address of Reporting Person
*
Salkind Gene |
2. Issuer Name and Ticker or Trading Symbol
Mobiquity Technologies, Inc.
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MOBQ
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
35 TORRINGTON LANE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/30/2021 |
(Street)
SHOREHAM, NY 11766
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock (2) | 9/30/2021 | | M | | 375000 | A | (1) | 1116021 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Preferred Stock (2) | (1) | 9/30/2021 | | M | | | 1500 (3) | 12/4/2018 | 9/30/2021 | Common stock | 750000 (4) | (5) | 1012500 (6) | D | |
Common Stock Purchase Warrants (2) | $48 | 9/30/2021 | | M | | 375000 | | 9/30/2021 | 9/20/2023 | Common Stock | 375000 | (5) | 1387500 | D | |
Explanation of Responses: |
(1) | Not applicable - reporting person converted oneshare of Series C preferred stock into 250 common shares and 250 warrants,exercisable at $48 per share. |
(2) | Includes securities or derivative securities heldboth jointly with his spouse and in trust. |
(3) | Represents 1,500 shares of Series C preferredstock converted into 375,000 shares of common stock and a like number ofwarrants, exercisable at $48 per share through September 20, 2023. |
(4) | Includes 375,000 common shares and 375,000warrants, exercisable at $48 per share through September 20, 2023. |
(5) | None. |
(6) | Includes 675,000 shares underlying $2.7million of debt convertible at $4 per share, with 50% warrant coverage (i.e. 337,500 warrants). The warrants are exercisable at $4per share through September 30, 2029, if and when, issued.The foregoing numbers exclude interest payable on the debt, which can also beconverted on the same basis. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Salkind Gene 35 TORRINGTON LANE SHOREHAM, NY 11766 | X | X |
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Signatures
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/s/ Gene Salkind | | 10/4/2021 |
**Signature of Reporting Person | Date |
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