SEC Form 3
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*
TELLEZ CORA M

(Last) (First) (Middle)
C/O CORMEDIX INC.
745 ROUTE 202-206, SUITE 303

(Street)
BRIDGEWATER NJ US 08807

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/22/2013
3. Issuer Name and Ticker or Trading Symbol
CorMedix Inc. [ CRMD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
04/07/2014
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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, $0.001 par value per share 200(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Series C-3 Non-Voting Convertible Preferred Stock(1)(2) (2) (2) Common Stock, $0.001 par value per share 50,000 $1 D
Common Stock Warrants (right to buy)(1)(2) 01/08/2014 01/08/2020 Common Stock, $0.001 par value per share 25,000 $1.25 D
Explanation of Responses:
1. This Form 3 amendment is being filed to correct the original Form 3 filed on April 7, 2014. The Common Stock, Series C-3 Non-Voting Convertible Preferred Stock and warrants were inadvertently omitted.
2. On January 8, 2014, the reporting person acquired through a private placement (i) 5,000 shares of the Company's Series C-3 Non-Voting Convertible Preferred Stock, each share is convertible into 10 shares of Common Stock, $0.001 par value per share; and (ii) a five-year warrant to purchase Common Stock at an exercise price of $1.25 per share. The Series C-3 Non-Voting Convertible Preferred Stock and warrants were purchased together at a purchase price of $10.00 per share.
/s/Alexander M. Donaldson 10/31/2014
** 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.
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