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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HOLMS VAL M. C/O BAKKEN RESOURCES, INC. 1425 BIRCH AVE., SUITE A HELENA, MT 59601 |
X | X | CEO and President |
/s/ Val M. Holms | 12/28/2011 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | These are restricted shares of common stock of Bakken Resources, Inc., par value $0.001 and are not currently registered under the Securities Act of 1933, as amended. |
(2) | The holders named herein previously held common stock of Bakken Resources, Inc. for the benefit of Mr. Val M. Holms. As of December 27, 2011, such securities have been reacquired by Mr. Holms in their respective entirety and re-issued in Mr. Holm's name. Prior named holders were: (a) John Reely with 1,350,000 shares of common stock, (b) K. Jeffrey Knapp with 1,000,000 shares of common stock, (c) Energi Resources, LLC with 1,419,000 shares of common stock and (d) Wolf Mountain Energies, LLC with 2,466,000 shares of common stock. |
(3) | See Footnote 2. |