Amended Statement of Beneficial Ownership (3/a)
11 Janvier 2020 - 12:10AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden hours per response...
0.5
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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
*
Matlack William Fuller |
2. Date of Event Requiring Statement (MM/DD/YYYY)
10/23/2019
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3. Issuer Name and Ticker or Trading Symbol
Timberline Resources Corp [TLRS]
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(Last)
(First)
(Middle)
C/O TIMBERLINE RESOURCES CORP., 101 EAST LAKESIDE AVENUE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
COEUR D'ALENE, ID 83814
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY) 1/10/2020
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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) |
Common stock | 13021679 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Series D Warrants | 9/9/2018 (1) | 4/30/2021 | Common shares | 2025000 | $0.14 | D | |
Series E Warrants | 3/9/2019 (1) | 10/29/2021 | Common shares | 3678979 | $0.14 | D | |
Series I Warrants | 11/9/2019 (1) | 11/7/2020 | Common shares | 3543600 | $0.07 | D | |
Series J Warrants | 2/24/2020 (1) | 10/15/2024 | Common shares | 3562500 | $0.12 | D | |
Series K Warrants | 4/8/2020 (1) | 1/20/2023 | Common shares | 4000000 | $0.08 | D | |
Stock options | 10/29/2019 | 10/29/2024 | Common shares | 404348 | $0.08 | D | |
Explanation of Responses: |
(1) | Warrants may not be exercised, except within 61 days of expiration, if such exercise would cause holder to beneficially own or exercise control or direction over 9.99% or greater of the issued and outstanding voting shares of the issuer. Warrants may not be exercised if such exercise would cause holder to beneficially own or exercise control or direction over 19.99% or greater of the issued and outstanding voting shares of the issuer. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Matlack William Fuller C/O TIMBERLINE RESOURCES CORP. 101 EAST LAKESIDE AVENUE COEUR D'ALENE, ID 83814 | X | X |
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Signatures
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William Matlack | | 1/10/2020 |
**Signature of Reporting Person | Date |
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