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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 05/20/2015 | 3. Issuer Name and Ticker or Trading Symbol NOVAMEX ENERGY INC. [ NGLE ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 06/01/2015 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Series A Preferred Stock, par value $0.001 per share | 0 | I | See footnotes(1)(2) |
Common Stock, par value $0.001 per share | 0 | I | See footnotes(1)(2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 |
Explanation of Responses: |
1. As a result of the Voting Agreement, dated May 20, 2015, by and among Novamex Energy Inc. ("Novamex"), Excellere Capital Group LLC ("Excellere"), and Gordon Payne, Jackson Payne, and Coleman Payne, Coleman Payne may be deemed to be the beneficial owner of (a) 3,500,034 shares of Series A Preferred Stock of Novamex held by Gordon Payne, (b) 3,499,983 shares of Series A Preferred Stock of Novamex held by Jackson Payne, and (c) 15,000,000 shares of Common Stock of Novamex held by Excellere, because Coleman Payne shares voting power over such shares pursuant to the Voting Agreement. Coleman Payne does not, however, have a pecuniary interest in such shares pursuant to Rule 16a-1(a)(2) of the Securities Exchange Act of 1934. |
2. This filing shall not be deemed an admission that Coleman Payne is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this statement. |
Remarks: |
This Form 3/A includes a copy of the power of attorney for Mr. Coleman Payne. Also, this Form 3/A amends and restates the indirect holdings beneficially held by Mr. Payne as provided in Table I on June 1, 2015. The prior indirect holdings in Table I were overstated as a result of administrative error. |
Coleman Payne, by Jason Nelson, Attorney-in-Fact | 06/02/2015 | |
** 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. |