| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
PureBase Corp [ PUBC ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/22/2019 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common stock | 03/22/2019 | 03/22/2019 | J(1) | 6,000,000 | D | (1) | 38,665,932 | D | ||
| Common stock | 06/26/2020 | 06/26/2020 | J(1) | 6,000,000 | A | (1) | 44,665,932 | D | ||
| Common stock | 08/24/2021 | 08/24/2021 | J(1) | 1,072,137 | D | (1) | 43,593,795 | D | ||
| Common stock | 08/24/2021 | 08/24/2021 | G | 2,500,000 | D | (2) | 41,093,795 | D | ||
| Common stock | 12/07/2021 | 12/07/2021 | J(1) | 1,150,000 | D | (1) | 39,943,795 | D | ||
| Common stock | 02/22/2022 | 02/22/2022 | J(1) | 1,400,000 | D | (1) | 38,543,795 | D | ||
| Common stock | 06/17/2022 | 06/17/2022 | J(1) | 500,000 | D | (1) | 38,043,795 | D | ||
| Common stock | 08/10/2022 | 08/10/2022 | J(1) | 1,000,000 | D | (1) | 37,043,795 | D | ||
| Common stock | 09/05/2019 | 09/05/2019 | J(3) | 60,248,484 | A | $0.09 | 60,248,484 | I | By Corporation | |
| Common stock | 02/03/2020 | 02/03/2020 | J(3) | 6,290,094 | A | $0.09 | 66,538,578 | I | By Corporation | |
| Common stock | 07/07/2020 | 07/20/2020 | J(3) | 6,720,905 | A | $0.16 | 73,259,483 | I | By Corporation | |
| Common stock | 07/07/2022 | 07/07/2022 | J(3) | 17,020,749 | A | $0.088 | 90,280,232 | I | By Corporation | |
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Stock option (right to buy) | $0.38 | 10/06/2021 | 10/06/2021 | J(4) | 116,000,000 | (5) | 04/06/2028 | Common Stock | 116,000,000(6) | $0.38 | 116,000,000 | I | By limited liability company | ||
| Explanation of Responses: |
| 1. Represents shares paid to third parties as consideration for making loans to the Reporting Person. |
| 2. Bona fide gift. |
| 3. Represents shares held by US Mine Corporation, of which the Reporting Person is a 33% owner. The Reporting Person disclaims beneficial ownership as to 66% of such shares. |
| 4. Option issued to US Mine Corp. as consideration for rights granted under a mineral extraction agreement with the Issuer. |
| 5. 58,000,000 shares subject to the option were exercisable as of 4/6/22, 29,000,000 shares vest and become exercisable on 10/6/22 and 29,000,000 shares vest and become exercisable on 4/6/23. |
| 6. Represents shares exercisable under an option held by US Mine LLC, of which the Reporting Person is a 33.3% owner. The Reporting Person disclaims beneficial ownership as to 66.6% of such shares. |
| /s/ A. Scott Dockter | 08/22/2022 | |
| ** 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 4 (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. | ||