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) | ||||||||||||||
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 | 3,499,983 | D | |
Series A Preferred Stock, par value $0.001 per share | 7,000,017 | I | See footnote(1) |
Common Stock, par value $0.001 per share | 15,000,000 | I | See footnote(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., Excellere Capital Group LLC, and Gordon Payne, Jackson Payne, and Coleman Payne (the "Voting Agreement"), Jackson Payne may be deemed to be the beneficial owner of 3,500,034 shares of Series A Preferred Stock of Novamex Energy Inc. held by Gordon Payne and 3,499,983 shares of Series A Preferred Stock of Novamex Energy Inc. held by Coleman Payne. |
2. As a result of the Voting Agreement, Jackson Payne may be deemed to be the beneficial owner of 15,000,000 shares of Common Stock of Novamex Energy Inc. held by Excellere Capital Group LLC. |
Jackson Payne, by Jason Nelson, as Attorney-in-Fact | 05/20/2015 | |
** 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. |