Sec Form 4 Filing - DIBELLA JOHN @ ENVIRO TECHNOLOGIES U.S., INC. - 2021-12-30

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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1. Name and Address of Reporting Person
DIBELLA JOHN
2. Issuer Name and Ticker or Trading Symbol
ENVIRO TECHNOLOGIES U.S., INC. [ EVTN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
X __ Officer (give title below) X __ Other (specify below)
CHIEF EXECUTIVE OFFICER/CHIEF FINANCIAL OFFICER
(Last) (First) (Middle)
821 NW 57 PLACE
3. Date of Earliest Transaction (MM/DD/YY)
12/30/2021
(Street)
FT. LAUDERDALE, FL33309
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/30/2021 A 500,000 A $ 0.25( 2 ) 1,626,462 D( 1 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
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 Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
DIBELLA JOHN
821 NW 57 PLACE
FT. LAUDERDALE, FL33309
X X CHIEF EXECUTIVE OFFICER CHIEF FINANCIAL OFFICER
Signatures
/s/ John A. DiBella 01/03/2022
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The number of shares of the Issuer's common stock owned by the Reporting Person includes 15,000 shares of common stock held for the benefit of the Reporting Person's minor children.
( 2 )The Reporting Person serves as the Issuer's chief executive officer and chief financial officer and as of September 30, 2021 the Issuer has accrued a salary expense of $795,565 payable to the Reporting Person which is reflected as an accrued expenses on the Issuer's balance sheet as of September 30, 2021 (the "Accrued Amount"). Effective December 30, 2021 the parties agreed to convert $125,000 of the Accrued Amount (the "Conversion Amount") into 500,000 restricted shares of common stock of the Company in full satisfaction of the Conversion Amount.

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 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).

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