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