Bay Shore Trust Form 3 MIRA PHARMACEUTICALS / George Cappy ownership change

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^*

Cappy George

(Last) (First) (Middle)

C/O MIRA PHARMACEUTICALS, INC.

900 WEST PLATT STREET, SUITE 200

(Street)

TAMPA FL 33606-2173

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
08/02/2023

3. Issuer Name and Ticker or Trading Symbol
MIRA PHARMACEUTICALS, INC. [ MIRA ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	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)

	Form filed by One Reporting Person
X	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	20,000	D(1)
Common Stock	2,583,100	I	By Trust(2)

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
Common Stock (right to buy)	04/28/2023	04/28/2028	Common Stock	1,000,000	5	I	By Trust(2)

1. Name and Address of Reporting Person^*

Cappy George

(Last) (First) (Middle)

C/O MIRA PHARMACEUTICALS, INC.

900 WEST PLATT STREET, SUITE 200

(Street)

TAMPA FL 33606-2173

(City) (State) (Zip)

1. Name and Address of Reporting Person^*

Bay Shore Trust

(Last) (First) (Middle)

C/O MIRA PHARMACEUTICALS, INC.

900 WEST PLATT STREET, SUITE 200

(Street)

TAMPA FL 33606-2173

(City) (State) (Zip)

Explanation of Responses:

1. These securities are owned directly by George Cappy ("Mr. Cappy").

2. These securities are owned directly by the Bay Shore Trust (the "Trust"), a 10% owner of the Issuer, and indirectly by Mr. Cappy as trustee of the Trust. Mr. Cappy disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.

	/s/ Michelle Yanez, Attorney-in-Fact for George Cappy	08/02/2023
	/s/ Michelle Yanez, Attorney-in-Fact for George Cappy, Trustee	08/02/2023
	** 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).
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