DSS, INC. — Director's Dealing 2016

Nov 21, 2016

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: DOCUMENT SECURITY SYSTEMS INC (DSS)
CIK: 0000771999
Period of Report: 2016-11-17

Reporting Person: Ronaldi Jeffrey (Director, CEO)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2016-11-17	Common Stock	A	125000	—	Acquired	272303	Direct

Footnotes

F1: Issued to the Reporting Person from Issuer's 2013 Employee, Director and Consultant Equity Incentive Plan for Services Provided to the Issuer.

F2: Common stock grant will fully vest six months from the date of issuance.

F3: Amount reflects a 1-for-4 reverse stock split which was affected by the company on August 26, 2016.