FORM 3
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Washington, D.C. 20549
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OMB APPROVAL
OMB Number: 3235-0104 Estimated average burden hours per response... 0.5 |
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Norris Patrick L.
INTERNATIONAL WESTERN PETROLEUM, INC. [INWP:OTCQB]
3011 W. ADMIRAL DOYLE DR,
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X
__ Director
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X
___ 10% Owner
NEW IBERIA, LA 70560
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X
_ Form filed by One Reporting Person
1. Name and Address of Reporting Person
*
2. Date of Event Requiring Statement (MM/DD/YYYY)
3. Issuer Name
and
Ticker or Trading Symbol
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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X
___ Officer (give title below)
_____ Other (specify below)
CEO, Pres, Sec, Treasurer /
5. If Amendment, Date Original Filed
(MM/DD/YYYY)
6. Individual or Joint/Group Filing
(Check Applicable Line)
___ 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
21500000
D
Common Stock
29920000
I
Held through JBB Partners, Inc.
Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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
Explanation of Responses: |
Reporting Owners
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Reporting Owner Name / Address |
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Director | 10% Owner | Officer | Other | ||
Norris Patrick L.
3011 W. ADMIRAL DOYLE DR, NEW IBERIA, LA 70560 |
X | X | CEO, Pres, Sec, Treasurer |
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Signatures
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/s/ Patrick Norris | 8/7/2017 | |
** Signature of Reporting Person |
Date
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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 control number. |