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*
Marques John

(Last) (First) (Middle)
C/O MUSCLE MAKER, INC.
308 EAST RENFRO STREET, SUITE 101

(Street)
BURLESON TX 76028

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/17/2018
3. Issuer Name and Ticker or Trading Symbol
Muscle Maker, Inc. [ MMB ]
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)
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 596,524 I Shares held by Membership LLC, which is controlled and owned solely by Mr. Marques.
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
Convertible Note 07/05/2017 08/31/2019 Common Stock 100,000 1 I Convertible Note held by Membership LLC, which is controlled and owned solely by Mr. Marques.
Convertible Note 01/24/2018 08/31/2019 Common Stock 100,000 1 D
Convertible Note 05/05/2018 08/31/2019 Common Stock 300,000 1 I Convertible Note held by Membership LLC, which is controlled and owned solely by Mr. Marques.
Warrant 03/29/2018 03/29/2021 Common Stock 30,769 1.625 I Warrant held by Membership LLC, which is controlled and owned solely by Mr. Marques.
Warrant 05/15/2018 05/05/2021 Common Stock 150,000 3.25 D
Explanation of Responses:
/s/ John Marques 09/20/2018
** 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.