Form 3 Attis Industries Inc.

Initial statement of beneficial ownership of securities

Published: 2019-03-15 09:59:12
Submitted: 2019-03-15
Period Ending In: 2018-10-09
ownership.html


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SEC FORM 3

SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Pilewicz John Gregory

(Last) (First) (Middle)
12540 BROADWELL ROAD, SUITE 2104

(Street)
MILTON GA 30004

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/09/2018
3. Issuer Name and Ticker or Trading Symbol
Attis Industries Inc. [ ATIS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
PRESIDENT
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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 Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: 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.
/s/ Gregory Pilewicz 03/15/2019
** 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 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 Number.
1
ownership.xml
Schema Version:
X0206
Document Type:
3
Period Of Report:
2018-10-09
No Securities Owned:
1

Issuer

Issuer Cik
0000949721
Issuer Name
Attis Industries Inc.
Issuer Trading Symbol
ATIS

Reporting Owner

Reporting Owner Id

Rpt Owner Cik
0001770591
Rpt Owner Name
Pilewicz John Gregory

Reporting Owner Address

Rpt Owner Street1
12540 BROADWELL ROAD, SUITE 2104
Rpt Owner City
MILTON
Rpt Owner State
GA
Rpt Owner Zip Code
30004

Reporting Owner Relationship

Is Director
0
Is Officer
1
Is Ten Percent Owner
0
Is Other
0
Officer Title
PRESIDENT

Owner Signature

Signature Name
/s/ Gregory Pilewicz
Signature Date
2019-03-15
Additional Files
FileSequenceDescriptionTypeSize
0001213900-19-004197.txt   Complete submission text file   3137
$ATIS

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