Statement of Changes in Beneficial Ownership (4)
January 04 2022 - 5:16PM
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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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
*
DIBELLA JOHN |
2. Issuer Name and Ticker or Trading Symbol
ENVIRO TECHNOLOGIES U.S., INC.
[
EVTN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner __X__ Officer (give title below) __X__ Other (specify below) CHIEF EXECUTIVE OFFICER
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CHIEF FINANCIAL OFFICER |
(Last)
(First)
(Middle)
821 NW 57 PLACE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/30/2021 |
(Street)
FT. LAUDERDALE, FL 33309
(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 | 12/30/2021 | | A | | 500000 | A | $0.25 (2) | 1626462 | D (1) | |
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 |
Explanation of Responses: |
(1) | The number of shares of the Issuer's common stock owned by the Reporting Person includes 15,000 shares of common stock held for the benefit of the Reporting Person's minor children. |
(2) | The Reporting Person serves as the Issuer's chief executive officer and chief financial officer and as of September 30, 2021 the Issuer has accrued a salary expense of $795,565 payable to the Reporting Person which is reflected as an accrued expenses on the Issuer's balance sheet as of September 30, 2021 (the "Accrued Amount"). Effective December 30, 2021 the parties agreed to convert $125,000 of the Accrued Amount (the "Conversion Amount") into 500,000 restricted shares of common stock of the Company in full satisfaction of the Conversion Amount. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
DIBELLA JOHN 821 NW 57 PLACE FT. LAUDERDALE, FL 33309 | X | X | CHIEF EXECUTIVE OFFICER | CHIEF FINANCIAL OFFICER |
Signatures
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/s/ John A. DiBella | | 1/3/2022 |
**Signature of Reporting Person | Date |
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