Statement of Changes in Beneficial Ownership (4)
14 Januar 2022 - 10:01PM
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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3235-0287
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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
*
Neukomm Daniel |
2. Issuer Name and Ticker or Trading Symbol
Revelstone Capital Acquisition Corp.
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RCACU
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Co-Chief Executive Officer |
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(Last)
(First)
(Middle)
14350 MYFORD ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/13/2022 |
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(Street)
IRVINE, CA 92606
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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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. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. 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 Date | 7. 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) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Class B Common Stock | (1) | 1/13/2022 | (1) | J (1) | | | 57130 | (1) | (1) | Class A Common Stock | 57130 | $0.00 | 550361 | D | |
| Class B Common Stock | (1) | 1/13/2022 | (1) | J (1) | | | 22500 | (1) | (1) | Class A Common Stock | 22500 | $0.00 | 495000 | I | See Footnote (2)(3) |
| Explanation of Responses: |
| (1) | As described in the issuer's registration statement on Form S-1 (File No. 333-261352) under the heading "Description of Securities," the shares of Class B common stock of the issuer will automatically convert into shares of Class A common stock of the issuer at the time of the issuer's initial business combination or earlier at the option of the holders thereof, on a one-for-one basis, subject to certain adjustments described therein, and have no expiration date. |
| (2) | As contemplated in connection with the initial public offering of the Issuer, 22,500 shares of Class B Common Stock of the Issuer were returned by La Jolla Group, Inc., the record holder of the securities reported herein, of which the reporting person is a director, for no consideration and cancelled because the underwriters' over-allotment option was not exercised in full. |
| (3) | La Jolla Group, Inc., is the record holder of the securities reported herein, of which the reporting person is a director. As a director of La Jolla Group, Inc., Mr. Neukomm has voting and dispositive power over the securities held directly by La Jolla Group, Inc., and disclaims any beneficial ownership of the reported shares other than to the extent of any pecuniary interest he may have therein, directly or indirectly. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Neukomm Daniel
14350 MYFORD ROAD
IRVINE, CA 92606 | X |
| Co-Chief Executive Officer |
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Signatures
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| Daniel Neukomm By: Daniel Neukomm. | | 1/14/2022 |
| **Signature of Reporting Person | Date |
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