| FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940 |
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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Lake Victoria Mining Company, Inc. [ LVCA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 04/30/2012 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 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 | ||||||
| Shares of Common Stock | 720,000 | D | ||||||||
| Shares of Common Stock | 16,201,000 | I | (1)(1) | |||||||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (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: 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 | ||||||||
| Warrants | $1.25 | 01/27/2010 | 01/27/2013 | Common | 750,000 | 750,000 | I | (2)(2) | |||||||
| Stock Options | $0.15(4) | 11/04/2011 | 11/04/2014 | Common | 1,000,000 | 1,750,000 | D | ||||||||
| Stock Options | $0.15(4) | 11/04/2011 | 11/04/2014 | Common | 840,000 | 2,590,000 | I | (3) | |||||||
| Stock Options | $0.09 | 04/30/2012 | A | 500,000 | 04/30/2012 | 04/30/2015 | common | 500,000 | $0.09 | 3,090,000 | D | ||||
| Stock Options | $0.09 | 04/30/2012 | A | 3,000,000 | 04/30/2012 | 04/30/2015 | common | 3,000,000 | $0.09 | 6,090,000 | I | (3)(3) | |||
| Explanation of Responses: |
| 1. Total consists of 16,186,000 shares held by Heidi Kalenuik, the spouse of Mr. Kalenuik, and 15,000 shares held by their children. |
| 2. Consists of 750,000 shares purchase warrants held by Heidi Kalenuik. |
| 3. Consists of 840,000 stock options held by Heidi Kalenuik. |
| 4. On November 4, 2011, the Issuer, David Kalenuik and Heidi Kalenuik agreed to cancel an aggregate of 1,840,000 previously issued options at an exercise price of $0.45 and the Issuer granted options to Mr. and Mrs. Kalenuik at a price of $0.15 in the amount of 840,000 and 1,000,000 respectively. |
| Remarks: |
| /s/ David Kalenuik | 05/02/2012 | |
| ** 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 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). | ||
| 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. | ||