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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
SERIES B PREFERRED STOCK | Â | 07/24/2006 | Â | C | Â | 16,300 | Â (3) | Â (3) | COMMON STOCK | (3) | 0 | Â | ||
SERIES A COMMON STOCK PURCHASE WARRANT | $ 1.5 | 08/11/2006 | Â | J4 | 2,024 | Â | Â (4) | Â (4) | COMMON STOCK | (4) | 35,358 (5) | BY SPOUSE. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MASTERS CHARLES G 4902 EISENHOWER BLVD. SUITE 185 TAMPA, FL 33634 |
 X |  X |  CHIEF EXECUTIVE OFFICER |  |
/s/ CHARLES G. MASTERS | 02/05/2007 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Received from issuer as a pro-rata dividend to all holders of Series A Convertible Preferred Stock. |
(2) | Includes 1,730,000 shares of common stock owned directly by the reporting person. The reporting person and his spouse both disclaim beneficial ownership of the other's securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. |
(3) | Each share of Series B Preferred Stock automatically converted into one hundred (100) shares of common stock upon the shareholders' approval of an increase in the authorized shares of the common stock of Deer Valley Corporation, which occurred on July 24, 2006. |
(4) | The Series A Common Stock Purchase Warrant was received from issuer as a contractually-mandated penalty in a pro-rata distribution to all holders of Series A Convertible Preferred Stock and is exerciseable in whole or in part for five years (5) from the date of grant, December 4, 2006, at a price of $1.50 per share. |
(5) | Includes a Series A Common Stock Purchase Warrant for 33,334 shares of common stock and a Series A Common Stock Purchase Warrant for 2,024 shares of common stock. In addition the reporting person indirectly beneficially owns, through his spouse, 2,500 shares of Series A Convertible Preferred Stock and a Series B Common Stock Purchase Warrant for 16,667 shares of common stock. The common shares underlying the derivative securities indirectly owned by the reporting person number 85,359. The reporting person and his spouse both disclaim beneficial ownership of the other's securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. |