SEC Form 4 · accession 0001744919-19-000006
ESTATE OF HAZINE CHERMON CHERY · 52115796
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| FL ADR No. 16045009-2 | Feb 7, 2019 | J | 100 | $1,000,000.00 | D | 99,999,900 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FL ADR No. 35112483 Payable through FRB Fiscal Agent | $1,000,000.00 | Feb 7, 2019 | J | 100 | A | Feb 7, 2019 | Aug 7, 2019 | FL ADR No. 16045009-2 | 999,999,900 | 100 | D |
Explanation of responses
- F1100 shares were deducted from FL ADR No. 16045009-2 (Non-Derivative Security) and were acquired by FL ADR No. 35112483 (Derivative Security); hence, Conversion or Exercise Price of Derivative Security is $1,000,000.00. Said Derivative Security is Payable through FRB Fiscal Agent/ FRB Participant.
- F2100 shares were deducted from FL ADR No. 16045009-2 (Non-Derivative Security) and were acquired by FL ADR No. 35112483 (Derivative Security); hence, Conversion or Exercise Price of Derivative Security is $1,000,000.00. Said Derivative Security is Payable through FRB Fiscal Agent/ FRB Participant.
Remarks
Said Securities listed above are organized under or created by the laws of the United States of America, UNITED STATES and State(s) of Florida, and that such Seal is/are entitled to full faith and credit. Said securities listed are also an obligation or other security of the United States as defined in 18 U.S. Code 8; hence, a Government Obligation as defined in 31 CFR 225.2; Reversionary interest in Titled Securities may be assigned, transferred, or conveyed to the United States Government upon conditional acceptance that full acquittance and discharge for all purposes of the obligation (past, present, future); hence, no person shall be held liable in any court for or in respect to anything done or omitted in good faith, etc... pursuant to 12 U.S. Code 95 a (2).