0001096906-17-000672.txt : 20171016 0001096906-17-000672.hdr.sgml : 20171016 20171016180621 ACCESSION NUMBER: 0001096906-17-000672 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170524 FILED AS OF DATE: 20171016 DATE AS OF CHANGE: 20171016 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOSOWSKY J ALLEN CENTRAL INDEX KEY: 0000925327 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-53979 FILM NUMBER: 171139582 MAIL ADDRESS: STREET 1: C/O THOR INDUSTRIES, INC. STREET 2: 419 WEST PIKE STREET CITY: JACKSON CENTER STATE: OH ZIP: 45334-0629 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BlackRidge Technology International, Inc. CENTRAL INDEX KEY: 0001456212 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 000000000 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 10615 PROFESSIONAL CIRCLE, SUITE 201 CITY: RENO STATE: NV ZIP: 89521 BUSINESS PHONE: 855-807-8776 MAIL ADDRESS: STREET 1: 10615 PROFESSIONAL CIRCLE, SUITE 201 CITY: RENO STATE: NV ZIP: 89521 FORMER COMPANY: FORMER CONFORMED NAME: GROTE MOLEN, INC. DATE OF NAME CHANGE: 20170605 FORMER COMPANY: FORMER CONFORMED NAME: GROTE MOLEN INC DATE OF NAME CHANGE: 20090212 3 1 primary_doc.xml PRIMARY DOCUMENT X0206 3 2017-05-24 0 0001456212 BlackRidge Technology International, Inc. BRTI 0000925327 KOSOWSKY J ALLEN 10615 PROFESSIONAL CIRCLE, SUITE 201 419 WEST PIKE STREET RENO NV 89521 1 0 0 0 Common Stock 83330 D Series A Preferred Stock 2017-02-22 Common Stock 83340 D Warrants 0.6 2017-02-10 2022-02-10 Common Stock 83330 D Warrants 0.6 2016-12-16 2021-12-16 Common Stock 83333 D The Series A Preferred Stock may be converted into common stock at the option of the holder at any time without consideration. It shall be automatically converted into common stock upon the occurrence of certain events as provided in its Certificate of Designation. By: /s/ J. Allen Kosowsky 2017-10-16