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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/08/2008 |
3. Issuer Name and Ticker or Trading Symbol
Celsius Holdings, Inc. [ CSUH.OB ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 11,184,016 | I | By CD Financial, LLC |
Common Stock | 100,000 | I | By self as trustee of revocable trust |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Series A Preferred Stock | 08/08/2008 | (1) | Common Stock | 25,000,000 | $0.08 | I | By CDS Ventures of South Florida, LLC |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Conversion option does not expire. |
Remarks: |
Carl DeSantis, an individual, holds beneficial ownership of (a) 100,000 common shares held by him as trustee of his revocable living trust, (b) 100% of the 11,184,016 common shares held by CD Financial, LLC, and (c) 100% of the 2,000 shares of Series A Preferred Stock (which is convertible into common stock as indicated in Table II) which are held by CDS Ventures of South Florida, LLC, the beneficial ownership of which is held by CD Financial, LLC of which Carl DeSantis holds 100% beneficial ownership. |
CD Financial, LLC, c/o CDS Int'l Holdings, Inc., 3299 N.W. 2nd Avenue, Boca Raton, FL 33431, By: W.H. Milmoe, Manager | 08/18/2008 | |
CDS Ventures of South Florida, LLC, c/o CDS Int'l Holdings, Inc., 3299 N.W. 2nd Avenue, Boca Raton, FL 33431, By: W.H. Milmoe, Manager | 08/18/2008 | |
Carl DeSantis, c/o CDS Int'l Holdings, Inc., 3299 N.W. 2nd Avenue, Boca Raton, FL 33431 | 08/18/2008 | |
** 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. |