Initial Statement of Beneficial Ownership (3)
03 Janeiro 2023 - 8:43PM
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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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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Mansano Roy |
2. Date of Event Requiring Statement (MM/DD/YYYY)
2/28/2022
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3. Issuer Name and Ticker or Trading Symbol
OKMIN RESOURCES, INC. [OKMN]
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(Last)
(First)
(Middle)
5343 OSTROM AVE. |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
ENCINO, CA 91316
(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
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Table I - Non-Derivative Securities Beneficially Owned
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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 Stock | 3000000 | D | |
Common Stock | 1250000 | I | By Roy Mansano MD APMC |
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) | 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 Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
10% Convertible Loan | 11/17/2021 | 5/8/2025 | Common Stock (1) | 7956667 | $0.03 | I | By Roy Mansano MD APMC |
Warrants | (2) | (3) | Common Stock | 2652222 | $0.03 | I | By Roy Mansano MD APMC |
Explanation of Responses: |
(1) | For every three shares of Common Stock received upon conversion of this loan, the holder will also receive one Warrant to buy an additional share of Common Stock at an exercise price of $0.03 per share. The number of such Warrants that the reporting person could acquire in that manner as of 3-10-22 is reported on the next line of this Form 3. |
(2) | These Warrants are not currently outstanding but may be issued upon conversion of the 10% Convertible Loan reported on the previous line of this Form 3. The Warrants will be exercisable immediately if and when issued. |
(3) | If and when issued, the Warrants will have a three year term. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Mansano Roy 5343 OSTROM AVE. ENCINO, CA 91316 |
| X |
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Signatures
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/s/ Roy Mansano | | 1/3/2023 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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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