0001493152-17-013703.txt : 20171121
0001493152-17-013703.hdr.sgml : 20171121
20171121214423
ACCESSION NUMBER: 0001493152-17-013703
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170921
FILED AS OF DATE: 20171121
DATE AS OF CHANGE: 20171121
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TAGLICH ROBERT
CENTRAL INDEX KEY: 0001353439
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-31671
FILM NUMBER: 171218269
MAIL ADDRESS:
STREET 1: 700 NEW YORK AVENUE
CITY: HUNTINGTON
STATE: NY
ZIP: 11743
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: INTELLINETICS, INC.
CENTRAL INDEX KEY: 0001081745
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 870613716
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2190 DIVIDEND DRIVE
CITY: COLUMBUS
STATE: OH
ZIP: 43228
BUSINESS PHONE: 6143888909
MAIL ADDRESS:
STREET 1: 2190 DIVIDEND DRIVE
CITY: COLUMBUS
STATE: OH
ZIP: 43228
FORMER COMPANY:
FORMER CONFORMED NAME: GLOBALWISE INVESTMENTS INC
DATE OF NAME CHANGE: 20000928
4
1
form4.xml
X0306
4
2017-09-21
0
0001081745
INTELLINETICS, INC.
INLX
0001353439
TAGLICH ROBERT
275 MADISON AVENUE,
#1618
NEW YORK
NY
10016
0
0
1
0
Convertible Note
0.30
2017-09-21
4
P
0
77320
75000
A
2017-09-21
Common stock
257733
1511305
D
Warrant
0.30
2017-09-21
4
P
0
75000
A
2017-09-21
2022-09-22
Common stock
75000
1586305
D
Warrants were issued in connection with Mr. Taglich's purchase of the $77,320 convertible note disclosed above.
/s/ Robert F. Taglich
2017-11-21