Initial Statement of Beneficial Ownership (3)
05 Juni 2018 - 11:59PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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
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1. Name and Address of Reporting Person
*
SHAW STEVEN A
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/3/2018
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3. Issuer Name
and
Ticker or Trading Symbol
VOLT INFORMATION SCIENCES, INC. [VISI]
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(Last)
(First)
(Middle)
1901 JEFFERSON AVENUE, SUITE 214
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
TACOMA, WA 98402
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, $0.01 par value
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192820
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D
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Common Stock, $0.01 par value
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9573
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I
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Trustee
(1)
(2)
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Common Stock, $0.01 par value
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1052583
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I
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Co-trustee
(1)
(2)
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Common Stock, $0.01 par value
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1401547
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I
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Co-trustee
(3)
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Common Stock, $0.01 par value
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12750
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I
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Officer and director of corporate owner
(2)
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Common Stock, $0.01 par value
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7650
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I
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Beneficiary of 401K of another
(4)
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Common Stock, $0.01 par value
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798
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I
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Beneficiary of ESOP of another
(5)
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Common Stock, $0.01 par value
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10000
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I
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Trustee
(3)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (Right to Buy)
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(6)
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4/6/2019
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Common Stock, $0.01 par value
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8000
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$6.39
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I
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Co-trustee
(3)
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Explanation of Responses:
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(1)
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Reporting Person is a trustee or co-trustee of a trust for the benefit of another.
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(2)
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Reporting Person disclaims any beneficial ownership of these shares. Reporting Person has no current pecuniary interest in these shares except as a trustee, co-trustee, officer or director.
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(3)
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Reporting Person is a trustee or co-trustee and a beneficiary of this trust.
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(4)
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Reporting Person is the beneficiary of on-third of the holdings in a 401K of another. Upon the death of Reporting Person's father on May 3, 2018, Reporting Person has the right to acquire these shares within 60 days.
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(5)
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Reporting Person is the beneficiary of one-third of the holdings of an ESOP plan of another. Upon the death of Reporting Person's father on May 3, 2018, Reporting Person has the right to acquire these shares within 60 days.
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(6)
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option vests in 20% annual installments, on a cumulative basis, commencing 4/7/2010, one year after the date of the original grant of the option.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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SHAW STEVEN A
1901 JEFFERSON AVENUE
SUITE 214
TACOMA, WA 98402
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X
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Signatures
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Steven Shaw
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6/5/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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