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*
Munn Max

(Last) (First) (Middle)
C/O APPLIED UV, INC.
510 N. MACQUESTEN PARKWAY

(Street)
MOUNT VERNON NY 10550

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/28/2020
3. Issuer Name and Ticker or Trading Symbol
Applied UV, Inc. [ AUVI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
President
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(1) 5,000,000 I See Footnote(1)
Series A Preferred Stock(2) 2,000 I See Footnote(2)
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
Warrant (Right to Buy) 04/01/2020 04/01/2025 Common Stock 80,000 (3) D
Non-Qualified Stock Option (Right to Buy) (4) 04/01/2030 Common Stock 500 (4) D
Non-Qualified Stock Option (Right to Buy) (5) 07/01/2030 Common Stock 500 (5) D
Explanation of Responses:
1. Includes 5,000,000 shares which are held in the name of The Munn Family 2020 Irrevocable Trust, for which the spouse of Max Munn is the trustee.
2. Held in the name of The Munn Family 2020 Irrevocable Trust, for which for which the spouse of Max Munn is the trustee. Each share of Series A Preferred Stock is entitled to 1,000 votes (2,000,000 votes in aggregate) and votes with the Company's common stock as a single class.
3. An exercise price is equal to the greater of (x) $5.00 per share and (y) the market value of common stock on April 1, 2020.
4. An exercise price is equal to the greater of (x) $2.50 per share and (y) the market value of common stock on April 1, 2020 (the "Effective Date of Grant"). Options for the purchase of 125 shares of common stock shall vest quarterly for a period of one year, beginning on the last day of the quarter following the Effective Date of Grant.
5. An exercise price is equal to the greater of (x) $2.50 per share and (y) the market value of common stock on July 1, 2020 (the "Effective Date of Grant"). Options for the purchase of 125 shares of common stock shall vest quarterly for a period of one year, beginning on the last day of the quarter following the Effective Date of Grant.
/s/ Max Munn 09/29/2020
** 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.