f4021315chariton

f4021315chariton_surgecomp.xml
Ownership Document
FORM 4
4
1 of 1
02/13/2015 01:27 PM
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
3235-0287
Expires:
Check this box if no longer
subject to Section 16. Form 4 or
Form 5 obligations may continue.
See Instruction 1(b).
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
2. Issuer Name and Ticker or Trading Symbol
(Check all applicable)
X
(First)
(Middle)
3. Date of Earliest Transaction (Month/Day/Year)
C/O SURGE COMPONENTS, INC.
95 EAST JEFRYN BOULEVARD
(Street)
NY
11729
(City)
(State)
(Zip)
Director
10% Owner
Officer (give title
below)
Other (specify
below)
02/12/2015
4. If Amendment, Date of Original Filed (Month/Day/Year)
DEER PARK
0.5
5. Relationship of Reporting Person(s) to Issuer
SURGE COMPONENTS INC [ SPRS ]
Chariton Lawrence
December 31, 2014
Estimated average
burden hours
per response
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
1. Name and Address of Reporting Person*
(Last)
OMB APPROVAL
OMB Number:
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 Acquired, Disposed of, or Beneficially Owned
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)
Code
Common Stock
02/12/2015
4. Securities Acquired (A) or
Disposed Of (D) (Instr. 3, 4 and
5)
V
M
Amount
(A) or
(D)
Price
25,000
A
$0.25
5. Amount of
Securities
Beneficially Owned
Following Reported
Transaction(s)
(Instr. 3 and 4)
6. Ownership
Form: Direct
(D) or Indirect
(I) (Instr. 4)
128,073(1)
7. Nature
of Indirect
Beneficial
Ownership
(Instr. 4)
D
Table II – Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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)
Code
Stock
Option
$0.25
02/12/2015
M
V
5. Number of
Derivative
Securities
Acquired (A) or
Disposed of (D)
(Instr. 3, 4
and 5)
(A)
(D)
25,000
6. Date Exercisable and
Expiration Date
(Month/Day/Year)
Date
Exercisable
7. Title and Amount of
Securities Underlying
Derivative Security
(Instr. 3 and 4)
Expiration
Date
05/06/2011 05/06/2015
Title
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)
$0
0
D
Amount
or
Number
of Shares
Common
25,000
Stock
Explanation of Responses:
1. Excludes 8,927 shares held by the reporting person's adult child, which shares had been included in the reporting person's prior ownership information.
Remarks:
/s/ Lawrence Chariton
02/13/2015
** 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.
11. Nature
of Indirect
Beneficial
Ownership
(Instr. 4)