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
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1. Name and Address of Reporting Person*
Mansano Roy

(Last) (First) (Middle)
5343 OSTROM AVE.

(Street)
ENCINO CA 91316

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/28/2022
3. Issuer Name and Ticker or Trading Symbol
OKMIN RESOURCES, INC. [ OKMN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 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 3,000,000 D
Common Stock 1,250,000 I By Roy Mansano MD APMC
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
10% Convertible Loan 11/17/2021 05/08/2025 Common Stock(1) 7,956,667 $0.03 I By Roy Mansano MD APMC
Warrants (2) (3) Common Stock 2,652,222 $0.03 I By Roy Mansano MD APMC
Explanation of Responses:
1. For every three shares of Common Stock received upon conversion of this loan, the holder will also receive one Warrant to buy an additional share of Common Stock at an exercise price of $0.03 per share. The number of such Warrants that the reporting person could acquire in that manner as of 3-10-22 is reported on the next line of this Form 3.
2. These Warrants are not currently outstanding but may be issued upon conversion of the 10% Convertible Loan reported on the previous line of this Form 3. The Warrants will be exercisable immediately if and when issued.
3. If and when issued, the Warrants will have a three year term.
/s/ Roy Mansano 01/03/2023
** 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.
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