- Amended Annual Statement of Changes in Beneficial Ownership (5/A)
2012年3月2日 - 5:11AM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[ ]
Form 3 Holdings Reported
[
X
]
Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Expires:
January 31, 2014
Estimated average burden
hours per response...
1.0
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public
Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
ZAMBER RONALD
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2. Issuer Name
and
Ticker or Trading Symbol
VICTORY ENERGY CORP [VYEYD]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
C/O VICTORY ENERGY CORPORATION, 20341 IRVINE AVENUE , SUITE D-6
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2010
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(Street)
NEWPORT BEACH, CA 92660
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
5/3/2011
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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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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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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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10% Senior Secured Convertible Debenture
(1)
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$
0.005
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12/31/2010
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J4
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110455000
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12/31/2010
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12/31/2013
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Common Stock
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110455000
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(2)
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117097226
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I
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By Visionary Investments, LLC
(3)
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Explanation of Responses:
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(
1)
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Reporting person inadvertently failed to disclose beneficial ownership of these securities owned indirectly by Visionary Investments, LLC.
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(
2)
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Pursuant to a Loan Extension Agreement between the Issuer and Visionary Investments, LLC dated December 31, 2010, the Issuer and Visionary Investments, LLC consolidated and otherwise converted multiple unsecured notes in the total amount of $497,000 and accrued interest in the total amount of $55,275 held by Visionary Investments, LLC into a 10% Senior Secured Convertible Debenture with a face value of $552,275.00.
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(
3)
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The securities are owned by Visionary Investments, LLC. The reporting person holds a 100% interest in Visionary Investments, LLC and is also the sole member. Reporting person disclaims beneficial ownership in the securities except to the extent of his pecuniary interest therein.
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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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ZAMBER RONALD
C/O VICTORY ENERGY CORPORATION
20341 IRVINE AVENUE , SUITE D-6
NEWPORT BEACH, CA 92660
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X
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Signatures
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/s/ Ronald Zamber
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3/1/2012
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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 4(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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