0001493152-21-029266.txt : 20211118
0001493152-21-029266.hdr.sgml : 20211118
20211118185832
ACCESSION NUMBER: 0001493152-21-029266
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211116
FILED AS OF DATE: 20211118
DATE AS OF CHANGE: 20211118
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Fredlake James J.
CENTRAL INDEX KEY: 0001734721
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38424
FILM NUMBER: 211425976
BUSINESS ADDRESS:
BUSINESS PHONE: 8132464999
MAIL ADDRESS:
STREET 1: 6130 LAZY DAYS BOULEVARD
CITY: SEFFNER
STATE: FL
ZIP: 33584
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Lazydays Holdings, Inc.
CENTRAL INDEX KEY: 0001721741
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 250 W 57TH STREET
STREET 2: SUITE 2223
CITY: NEW YORK
STATE: NY
ZIP: 10107
BUSINESS PHONE: 646-565-3861
MAIL ADDRESS:
STREET 1: 250 W 57TH STREET
STREET 2: SUITE 2223
CITY: NEW YORK
STATE: NY
ZIP: 10107
FORMER COMPANY:
FORMER CONFORMED NAME: Andina II Holdco Corp.
DATE OF NAME CHANGE: 20171103
4
1
ownership.xml
X0306
4
2021-11-16
0
0001721741
Lazydays Holdings, Inc.
LAZY
0001734721
Fredlake James J.
C/O LAZYDAYS HOLDINGS, INC.,
6130 LAZY DAYS BOULEVARD
SEFFNER,
FL
33584
1
0
0
0
Common Stock
2021-11-16
5
G
0
E
5000
0.00
D
4544
I
See Footnote
Common Stock
19836
D
Represents shares held by the James J. Fredlake Revocable Trust of 2017, of which the reporting person is the trustee and a beneficiary. Reflects the gift of common stock to a charitable donor advised fund.
/s/ James J Fredlake
2021-11-18