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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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Hollister John B. III
PEN INC. [PENC]
701 BRICKELL AVE., SUITE 1550
_____ Director
_____ 10% Owner
MIAMI, FL 33131
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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)
Chief Financial Officer /
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)
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: |
| No securities are beneficially owned. |
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Reporting Owners
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| Reporting Owner Name / Address |
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| Director | 10% Owner | Officer | Other | ||
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Hollister John B. III
701 BRICKELL AVE., SUITE 1550 MIAMI, FL 33131 |
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Chief Financial Officer |
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Signatures
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| /s/ John B Hollister | 6/10/2016 | |
| ** 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. | |