And...
Statement of Changes in Beneficial Ownership (4)
And a change in beneficial ownership. Each of these were related to the completed acquisitions.
Source: Edgar (US Regulatory)
FORM 4
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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 *
MAINARDI ANGELA2. Issuer Nameand Ticker or Trading Symbol
Fortem Resources Inc. [ FTMR ]5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director __X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
1503 COMMERCIAL DRIVE3. Date of Earliest Transaction(MM/DD/YYYY)
4/12/2017(Street)
VANCOUVER, A1 V5L 3Y1(City) (State) (Zip)4. 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 Acquired, Disposed of, or Beneficially Owned1.Title of Security
(Instr. 3)2. Trans. Date2A. Deemed Execution Date, if any3. Trans. 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)CodeVAmount(A) or (D)PriceCommon Stock 10000000 I Pacific Petroleum, LLC Common Stock 4/12/2017 J (1) 10000000 A$2.00 20000000 I Pacific Petroleum, LLC
Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)1. Title of Derivate Security
(Instr. 3)2. Conversion or Exercise Price of Derivative Security3. Trans. Date3A. Deemed Execution Date, if any4. Trans. Code
(Instr. 8)5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)6. Date Exercisable and Expiration Date7. 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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)11. Nature of Indirect Beneficial Ownership (Instr. 4)CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Explanation of Responses:(1) These shares were acquired as consideration for the sale of a membership interest held by Pacific Petroleum, LLC in Black Dragon, LLC.
Reporting Owners
Reporting Owner Name / AddressRelationshipsDirector10% OwnerOfficerOtherMAINARDI ANGELA
1503 COMMERCIAL DRIVE
VANCOUVER, A1 V5L 3Y1
X
Signatures
/s/ Angela Mainardi5/15/2017** Signature of Reporting PersonDate
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