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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person*
| C/O DECARBONIZATION PLUS ACQ CORP III |
| 2744 SAND HILL ROAD, SUITE 100 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/23/2021
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3. Issuer Name and Ticker or Trading Symbol
Decarbonization Plus Acquisition Corp III
[ DCRC ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| See Remarks |
|
5. If Amendment, Date of Original Filed
(Month/Day/Year)
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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)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| No securities beneficially owned. |
0 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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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 |
| Explanation of Responses: |
| Remarks: |
|
|
/s/ Peter Haskopoulos |
03/23/2021 |
|
** 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. |
Exhibit 24
POWER OF ATTORNEY
Known all by these presents, that the undersigned hereby constitutes and
appoints Peter Haskopoulos and Erik J. Anderson of Decarbonization Plus
Acquisition Corporation III (the "Company") or any of them signing singly, and
with full power of substitution, the undersigned's true and lawful attorney-
in-fact to:
1. prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit to the U.S. Securities and Exchange Commission
(the "SEC") a Form ID, including amendments thereto, and any other
documents necessary or appropriate to obtain codes and passwords
enabling the undersigned to make electronic filings with the SEC of
reports required by Section 16(a) of the Securities Exchange Act of
1934 (the "Exchange Act") or any rule or regulation of the SEC;
2. execute for and on behalf of the undersigned with respect to the
Company, Schedules 13D and 13G and Forms 3, 4, and 5 in accordance
with Sections 13 and 16(a) of the Exchange Act and the rules
thereunder;
3. do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any
such Schedules 13D or 13G or Form 3, 4, or 5, complete and execute
any amendment or amendments thereto, and timely file such form with
the SEC and any stock exchange or similar authority; and
4. take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be
of benefit to, in the best interest of, or legally required by, the
undersigned, it being understood that the documents executed by such
attorney-in-fact on behalf of the undersigned pursuant to this
Power of Attorney shall be in such form and shall contain such
terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and
powers herein granted, as fully to all intents and purposes as the undersigned
might or could do if personally present, with full power of substitution or
revocation, hereby ratifying and confirming all that such attorney-in-fact, or
such attorney-in-fact's substitute or substitutes, shall lawfully do or cause
to be done by virtue of this power of attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming any of the undersigned's responsibilities to comply
with Sections 13 and 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to
the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing
delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this twenty-third day of March, 2021.
ERIK ANDERSON
/s/ Erik Anderson
----------------------------------------
Name: Erik Anderson
PETER HASKOPOULOS
/s/ Peter Haskopoulos
----------------------------------------
Name: Peter Haskopoulos
PIERRE F. LAPEYRE, JR.
/s/ Pierre F. Lapeyre, Jr.
----------------------------------------
Name: Pierre F. Lapeyre, Jr.
DAVID M. LEUSCHEN
/s/ David M. Leuschen
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Name: David M. Leuschen
ROBERT TICHIO
/s/ Robert Tichio
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Name: Robert Tichio
JAMES AC MCDERMOTT
/s/ James AC McDermott
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Name: James AC McDermott
JEFFREY H. TEPPER
/s/ Jeffrey H. Tepper
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Name: Jeffrey H. Tepper
JENNIFER AAKER
/s/ Jennifer Aaker
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Name: Jennifer Aaker
JANE KEARNS
/s/ Jane Kearns
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Name: Jane Kearns
MICHAEL WARREN
/s/ Michael Warren
----------------------------------------
Name: Michael Warren
