0001161351-15-000004.txt : 20151102 0001161351-15-000004.hdr.sgml : 20151102 20151102200004 ACCESSION NUMBER: 0001161351-15-000004 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150831 FILED AS OF DATE: 20151102 DATE AS OF CHANGE: 20151102 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MIX 1 LIFE, INC. CENTRAL INDEX KEY: 0001501112 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 680678499 STATE OF INCORPORATION: NV FISCAL YEAR END: 0831 BUSINESS ADDRESS: STREET 1: 10575 N. 114TH STREET 2: SUITE 103 CITY: SCOTTSDALE STATE: AZ ZIP: 85259 BUSINESS PHONE: 480-344-7770 MAIL ADDRESS: STREET 1: 10575 N. 114TH STREET 2: SUITE 103 CITY: SCOTTSDALE STATE: AZ ZIP: 85259 FORMER COMPANY: FORMER CONFORMED NAME: Antaga International Corp DATE OF NAME CHANGE: 20121003 FORMER COMPANY: FORMER CONFORMED NAME: Antaga Internatinal Corp DATE OF NAME CHANGE: 20100910 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Larson Christopher CENTRAL INDEX KEY: 0001161351 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55422 FILM NUMBER: 151191961 MAIL ADDRESS: STREET 1: 16000 N. 80TH STREET, SUITE E CITY: SCOTTSDALE STATE: AZ ZIP: 85260 FORMER NAME: FORMER CONFORMED NAME: LARSON CHRISTOPHER DATE OF NAME CHANGE: 20011022 5 1 primary_doc.xml PRIMARY DOCUMENT X0306 5 2015-08-31 0 0 0 0001501112 MIX 1 LIFE, INC. MIXX 0001161351 Larson Christopher 16000 N. 80TH STREET, SUITE E SCOTTSDALE AZ 85260 1 1 1 0 CFO Common Stock 2015-10-27 5 P 0 10650 1.11 A 103952 D Common Stock 1711984 I See Footnote The amount of shares owned directly is as of the date of this filing. Indirect Ownership includes 150 shares in the name of Mr. Larson's minor child, 78,500 common shares held in the name of Thomas Lake & Company, a corporation controlled by Mr. Larson, and 1,633,334 common shares held in the name of Mix Development Group LLC, an Arizona limited liability company controlled by Mr. Larson. Christopher Larson 2015-11-02