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