| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
| Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
PepperBall Technologies, Inc. [ PBAL ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 04/22/2009 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Convertible Promissory Note | $0.1 | 04/22/2009 | P | $100,000 | (1) | (1) | See note(1) | (1) | $100,000 | $100,000 | I | By The John C. Stiska Trust dtd 11/14/00(4) | |||
| Convertible Promissory Note | $0.1 | 04/22/2009 | J(2) | $616,834 | (3) | (3) | See note(3) | (3) | $616,834 | $616,834 | I | By The John C. Stiska Trust dtd 11/14/00(4) | |||
| Explanation of Responses: |
| 1. The note has a principal amount of $100,000, bears interest at the rate of 10% per annum and matures on December 31, 2010. The reporting person has the right from time to time to convert all or any portion of the indebtedness owning under the note into shares of issuer's common stock or non-voting Series C Preferred Stock at a conversion price of $0.10 per share. |
| 2. The note was obtained in a transaction under Section 3(a)(9) of the Securities Act in exchange for a note that had a principal balance of $565,000 and $51,834 in accrued interest (the "Original Note") at the time of the exchange. The Original Note matured on December 19, 2009. The reporting person had the right to convert all or any portion of the indebtedness owing under the Original Note into shares of the issuer's common stock at a conversion price equal to the average closing price of the issuer's common stock on the Nasdaq Capital Market (or such other exchange or quotation service on which the issuer's common stock is listed or quoted at such time, as the case may be) for the six-month period ended on the trading day immediately prior to the date the reporting person requested such conversion. |
| 3. The note has a principal amount of $616,834, bears interest at the rate of 10% per annum and matures on December 31, 2010. The reporting person has the right from time to time to convert all or any portion of the indebtedness owning under the note into shares of issuer's common stock or non-voting Series C Preferred Stock at a conversion price of $0.10 per share. |
| 4. The reporting person is the Trustee of the John C. Stiska Trust dtd 11/14/00. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest in the named entity, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of all of the reported securities for purposes of Section 16 or any other purpose. |
| /s/ John C. Stiska | 04/24/2009 | |
| ** Signature of Reporting Person | Date | |
| 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 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). | ||
| 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 Number. | ||