Initial Statement of Beneficial Ownership (3)
October 23 2017 - 5:50PM
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
Estimated average burden
hours per response...
0.5
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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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Kveton Scott C
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2. Date of Event Requiring Statement (MM/DD/YYYY)
10/16/2017
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3. Issuer Name
and
Ticker or Trading Symbol
MassRoots, Inc. [MSRT]
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(Last)
(First)
(Middle)
105 SW 85TH AVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Chief Executive Officer /
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(Street)
PORTLAND, OR 97225
(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, par value $0.001
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2826877
(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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Pursuant to the Agreement and Plan of Merger as described on the Company's Form 8-K dated July 14, 2017, Mr. Kveton received 1,228,771 shares of the Company's Common Stock as consideration for the merger of the Company's subsidiary, MassRoots Compliance Technology, Inc., with and into Odava, Inc. (the "Merger"). In addition, as consideration for the Merger, 48,106 shares of the Company's Common Stock were issued to Mr. Kveton and Sarah Tuthill-Kveton, as joint tenants with right of survivorship. Pursuant to that certain Employment Agreement between the Company and Mr. Kveton, dated June 28, 2017, Mr. Kveton was granted (i) 50,000 shares of the Company's Common Stock which vested immediately, and (ii) 1,500,000 shares of the Company's Common Stock, which vest equally over the course of 24 months starting July 1, 2017 (250,000 shares of which have vested as of the date of this filing).
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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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Kveton Scott C
105 SW 85TH AVE
PORTLAND, OR 97225
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Chief Executive Officer
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Signatures
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Scott C. Kveton
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10/23/2017
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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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