Initial Statement of Beneficial Ownership (3)
September 12 2017 - 4:27PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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LANDERS VADEN CECIL
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2. Date of Event Requiring Statement (MM/DD/YYYY)
9/1/2017
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3. Issuer Name
and
Ticker or Trading Symbol
PAYMENT DATA SYSTEMS INC [PYDS]
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(Last)
(First)
(Middle)
C/O PAYMENT DATA SYSTEMS, INC., 12500 SAN PEDRO, SUITE 120
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
___
X
___ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Chief Revenue Officer /
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(Street)
SAN ANTONIO, TX 78216
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, $0.001 par value per share
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1815152
(1)
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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300,000 of the shares of common stock were issued to the reporting person in connection with the entry into an employment agreement with the issuer. The 300,000 shares of common stock vest on 09/01/2027 or earlier upon a change of control or other events as specified in the employment agreement. The remaining 1,515,152 shares were issued to the reporting owner as a result of the sale of all membership rights in Singular Payments, LLC.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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LANDERS VADEN CECIL
C/O PAYMENT DATA SYSTEMS, INC.
12500 SAN PEDRO, SUITE 120
SAN ANTONIO, TX 78216
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X
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Chief Revenue Officer
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Signatures
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Vaden Landers
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9/12/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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