FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/19/2008 |
3. Issuer Name and Ticker or Trading Symbol
PepperBall Technologies, Inc. [ PBAL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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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 | 312,837(1) | I | By the Nash Family Trust dated 3/18/80(3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 | ||||
Convertible Promissory Note | (2) | (2) | Common Stock | (2) | (2) | I | By the Nash Family Trust dated 3/18/80(3) |
Explanation of Responses: |
1. Reflects a 1-for-2 reverse stock split effected on September 29, 2008. |
2. The note has a principal amount of $215,000, bears interest (accruing to maturity) at the rate of 10% per annum and matures on December 19, 2009. The reporting person has the right from time to time to convert all or any portion of the indebtedness owing under the Note into shares of the issuer's Common Stock at a conversion price equal to the average closing price of the issuer's Common Stock on the Nasdaq Capital Market (or such other exchange or quotation service on which the issuer's Common Stock is listed or quoted at such time, as the case may be) for the six-month period ended on the trading day immediately prior to the date the reporting person requests such conversion. |
3. Jeffrey M. Nash and Kathleen L. Nash are the Trustees of the Nash Family Trust dated 3/18/80. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest in the named entity, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of all of the reported securities for purposes of Section 16 or any other purpose. |
/s/ Jeffrey M. Nash | 09/24/2008 | |
** 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 Number. |