0001493152-21-022755.txt : 20210914 0001493152-21-022755.hdr.sgml : 20210914 20210914213012 ACCESSION NUMBER: 0001493152-21-022755 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: FARKAS MICHAEL D CENTRAL INDEX KEY: 0001128728 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40809 FILM NUMBER: 211254000 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 0001128728 FARKAS MICHAEL D C/O EZFILL HOLDINGS, INC. 2125 BISCAYNE BLVD, #309 MIAMI FL 33137 0 0 1 0 Common Stock 6740933 I See Notes Stock Option (right to buy) 1.35 2019-07-03 2024-07-03 Common Stock 7440 I Options held by the Farkas Group, Inc. (See Note) Stock Option (right to buy) 1.35 2019-07-12 2024-07-12 Common Stock 7440 I Options held by the Farkas Group, Inc. (See Note) Stock Option (right to buy) 1.35 2019-07-29 2024-07-29 Common Stock 7440 I Options held by the Farkas Group, Inc. (See Note) Stock Option (right to buy) 1.35 2019-12-05 2024-12-05 Common Stock 3720 I Options held by the Farkas Group, Inc. (See Note) Stock Option (right to buy) 0.62 2019-12-24 2024-12-24 Common Stock 3720 I Options held by the Farkas Group, Inc. (See Note) Stock Option (right to buy) 0.62 2020-01-17 2025-01-17 Common Stock 7440 I Options held by the Farkas Group, Inc. (See Note) Michael D. Farkas is the President of the Farkas Group, Inc. and beneficially owns 3,378,674 shares of common stock held by the Farkas Group, Inc. Michael D. Farkas is the Manager of SIF Energy LLC and beneficially owns 3,096,531 shares of common stock held by SIF Energy LLC. Michael D. Farkas is the Chief Executive Officer of Balance Labs, Inc. and beneficially owns 265,728 shares of common stock held by Balance Labs, Inc. Michael D. Farkas is the President of the Farkas Group, Inc. and beneficially owns the options and underlying shares held by the Farkas Group, Inc. /s/ Michael D. Farkas 2021-09-14