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*
LENX ST Investor, LLC

(Last) (First) (Middle)
700 NW 107TH AVE SUITE 400

(Street)
MIAMI FL 33172

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/28/2021
3. Issuer Name and Ticker or Trading Symbol
Doma Holdings, Inc. [ DOMA ]
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)
Form filed by One Reporting Person
X 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(1) 82,242,689 D
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
1. Name and Address of Reporting Person*
LENX ST Investor, LLC

(Last) (First) (Middle)
700 NW 107TH AVE SUITE 400

(Street)
MIAMI FL 33172

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Len X, LLC

(Last) (First) (Middle)
700 NW 107TH AVE SUITE 400

(Street)
MIAMI FL 33172

(City) (State) (Zip)
1. Name and Address of Reporting Person*
LENNAR CORP /NEW/

(Last) (First) (Middle)
700 NW 107TH AVE SUITE 400

(Street)
MIAMI FL 33172

(City) (State) (Zip)
Explanation of Responses:
1. Received in exchange for shares of common stock of Doma Holdings, Inc., which was formerly known as States Title Holding, Inc. ("Former Doma"), in connection with the merger by and among Capitol Investment Corp V., Capitol V Merger Sub, Inc. and Former Doma (the "Merger"). The securities are directly owned by LENX ST Investor, LLC, the sole member of which is LEN X, LLC ("LENX"), which is a wholly-owned subsidiary of Lennar Corporation ("Lennar"), a publicly traded company with its stock listed on the NYSE. LENX and Lennar are indirect beneficial owners and disclaim beneficial ownership except to the extent of their pecuniary interest therein.
/s/ Mark Sustana as VP, GC and Secretary of Lennar Corporation 08/03/2021
/s/ Mark Sustana as VP of LEN X, LLC 08/03/2021
/s/ Mark Sustana as VP of LENX ST Investor, LLC 08/03/2021
** 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.