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

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

ROY MICHAEL J

2. Date of Event Requiring Statement (MM/DD/YYYY)
5/12/2011 

3. Issuer Name and Ticker or Trading Symbol

DOCUMENT SECURITY SYSTEMS INC [DMC]

(Last)        (First)        (Middle)

22 SIMONE TERRACE

4. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                            _____ 10% Owner
___ X ___ Officer (give title below)          _____ Other (specify below)
President, Digital Division /

(Street)

WEBSTER, NY 14580       

(City)              (State)              (Zip)
5. If Amendment, Date Original Filed (MM/DD/YYYY)

 

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)
COMMON STOCK   (1) 47168   D    

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
OPTIONS   (2)   (2) 5/11/2016   COMMON STOCK   32832   $3.33   D    

Explanation of Responses:
( 1)  Common stock grant from the Company's 2004 Employee Stock Option Plan, as amended, which vests pro ratably in four equal installments on May 12, 2012, 2013, 2014 and 2015.
( 2)  Options grant from the Company's 2004 Employee Stock Option Plan, as amended, which vests pro ratably in four equal installments on May 12, 2012, 2013, 2014 and 2015.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
ROY MICHAEL J
22 SIMONE TERRACE
WEBSTER, NY 14580


President, Digital Division

Signatures
/s/ Michael J. Roy 5/20/2011
** 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 control number.
Document Security (AMEX:DMC)
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Document Security (AMEX:DMC)
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부터 12월(12) 2023 으로 12월(12) 2024 Document Security 차트를 더 보려면 여기를 클릭.