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Adelman Dean AFORM 3UNITED 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 1940OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response:
0.5OMB APPROVALOMB Number:
3235-0104
Estimated average burden
hours per response:
0.5OMB Number:3235-0104Estimated average burdenhours per response:1. Name and Address of Reporting Person*Adelman Dean A
(Last)
(First)
(Middle)
1000 ABERNATHY ROAD STE. 1700
(Street)
ATLANTA
GA
30328
(City)
(State)
(Zip)(Last)(First)(Middle)1000 ABERNATHY ROAD STE. 1700ATLANTAGA(City)(State)(Zip)2. Date of Event Requiring Statement
(Month/Day/Year)
03/11/20193. Issuer Name and Ticker or Trading Symbol
Veritiv Corp
[ VRTV ]4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director
10% Owner
X
Officer (give title below)
Other (specify below)
SVP and Chief HR OfficerDirector10% OwnerXOfficer (give title below)Other (specify below)SVP and Chief HR Officer5. 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 PersonForm filed by One Reporting PersonForm filed by More than One Reporting PersonTable 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 Security5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)6. Nature of Indirect Beneficial Ownership (Instr.
5)Date ExercisableExpiration DateTitleAmount or Number of SharesExplanation of Responses:Remarks:Power of Attorney attached as Exhibit 24.1No securities are beneficially owned./s/ Mark W. Hianik, Attorney-in-Fact for Dean A. Adelman03/20/2019** Signature of Reporting PersonDateReminder: 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.PK !