0001493152-21-022752.txt : 20210914
0001493152-21-022752.hdr.sgml : 20210914
20210914212715
ACCESSION NUMBER: 0001493152-21-022752
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210914
FILED AS OF DATE: 20210914
DATE AS OF CHANGE: 20210914
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LEVINE JACK
CENTRAL INDEX KEY: 0001124852
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40809
FILM NUMBER: 211253987
MAIL ADDRESS:
STREET 1: C/O BLINK CHARGING CO.
STREET 2: 407 LINCOLN ROAD, SUITE 704
CITY: MIAMI BEACH
STATE: FL
ZIP: 33139
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EzFill Holdings Inc
CENTRAL INDEX KEY: 0001817004
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500]
IRS NUMBER: 834260623
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2125 BISCAYNE BLVD
STREET 2: #309
CITY: MIAMI
STATE: FL
ZIP: 33137
BUSINESS PHONE: 305-791-1169
MAIL ADDRESS:
STREET 1: 2125 BISCAYNE BLVD
STREET 2: #309
CITY: MIAMI
STATE: FL
ZIP: 33137
3
1
ownership.xml
X0206
3
2021-09-14
0
0001817004
EzFill Holdings Inc
EZFL
0001124852
LEVINE JACK
C/O EZFILL HOLDINGS, INC.
2125 BISCAYNE BLVD, #309
MIAMI
FL
33137
1
0
0
0
Common Stock
186010
D
Common Stock
13286
I
Cameo Life Sciences Investments LLC. See Note
Jack Levine is the Manager of Cameo Life Sciences Investments LLC and beneficially owns 13,286 shares of common stock, which are held by Cameo Life Sciences Investments, LLC.
/s/ Jack Levine
2021-09-14