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
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1. Name and Address of Reporting Person*
Aryeh Jason

(Last) (First) (Middle)
C/O ANEBULO PHARMACEUTICALS, INC.
1415 RANCH ROAD 620 SOUTH, SUITE 201

(Street)
LAKEWAY TX 78734

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/06/2021
3. Issuer Name and Ticker or Trading Symbol
Anebulo Pharmaceuticals, Inc. [ ANEB ]
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)
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
Options to purchase Common Stock (1) (1) Common Stock 82,290(2) 2.18(2) D
Explanation of Responses:
1. On March 1, 2021, Mr. Aryeh received options to purchase 82,290 shares of common stock granted under the Anebulo Pharmaceuticals, Inc. 2020 Stock Incentive Plan. The options are exercisable in four equal annual installments starting on March 1, 2022 and expire on February 28, 2026.
2. Such numbers reflect a 6-for-1 forward stock split.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Rex Merchant, as Attorney-in-Fact 05/06/2021
** 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.