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LQR HOUSE INC.
Date Filed :
Aug 14, 2023
View Exhibits
SEC FORM 3
SEC Form 3
FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response:
0.5
1. Name and Address of Reporting Person
*
Dollinger Guy
(Last)
(First)
(Middle)
283 RUE PICASSO
(Street)
DOLLARD-DES-ORMEAUX
A8
H9A 2K2
(City)
(State)
(Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/09/2023
3. Issuer Name
and
Ticker or Trading Symbol
LQR House Inc.
[
LQR
]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X
Director
10% Owner
Officer (give title below)
Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
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
25,000
D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)
2. Date Exercisable and Expiration Date (Month/Day/Year)
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)
4. Conversion or Exercise Price of Derivative Security
5. Ownership Form: 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
Restricted Stock Units
(1)
(2)
Common Stock
50,000
(3)
D
Explanation of Responses:
1. 08/09/2023 RSU Grant - Vesting Date: The RSUs vests in eight (8) equal quarterly installments commencing in the quarter following August 9, 2023, subject to the reporting person's continued service to LQR on each vesting date.
2. RSU Expiration Date: This award has no expiration date. RSUs will either vest or be forfeited.
3. RSU Exercise Price: There is no exercise price associated with the grant of RSUs. RSUs convert into common stock on a one-for-one basis upon vesting and settlement.
/s/ Guy Dollinger
08/14/2023
** 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 Number.
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