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*
Matlack William Fuller

(Last) (First) (Middle)
C/O TIMBERLINE RESOURCES CORP.
101 EAST LAKESIDE AVENUE

(Street)
COEUR D'ALENE ID 83814

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/23/2019
3. Issuer Name and Ticker or Trading Symbol
Timberline Resources Corp [ TLRS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
01/10/2020
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 13,021,679 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 D Warrants 09/09/2018(1) 04/30/2021 Common shares 2,025,000 0.14 D
Series E Warrants 03/09/2019(1) 10/29/2021 Common shares 3,678,979 0.14 D
Series I Warrants 11/09/2019(1) 11/07/2020 Common shares 3,543,600 0.07 D
Series J Warrants 02/24/2020(1) 10/15/2024 Common shares 3,562,500 0.12 D
Series K Warrants 04/08/2020(1) 01/20/2023 Common shares 4,000,000 0.08 D
Stock options 10/29/2019 10/29/2024 Common shares 404,348 0.08 D
Explanation of Responses:
1. Warrants may not be exercised, except within 61 days of expiration, if such exercise would cause holder to beneficially own or exercise control or direction over 9.99% or greater of the issued and outstanding voting shares of the issuer. Warrants may not be exercised if such exercise would cause holder to beneficially own or exercise control or direction over 19.99% or greater of the issued and outstanding voting shares of the issuer.
William Matlack 01/10/2020
** 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.