0001415889-23-002824.txt : 20230221 0001415889-23-002824.hdr.sgml : 20230221 20230221111757 ACCESSION NUMBER: 0001415889-23-002824 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230217 FILED AS OF DATE: 20230221 DATE AS OF CHANGE: 20230221 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Novak Damian CENTRAL INDEX KEY: 0001898426 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41147 FILM NUMBER: 23646160 MAIL ADDRESS: STREET 1: 505 HIGHWAY 169 NORTH STREET 2: SUITE 255 CITY: PLYMOUTH STATE: MN ZIP: 55441 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fresh Vine Wine, Inc. CENTRAL INDEX KEY: 0001880343 STANDARD INDUSTRIAL CLASSIFICATION: BEVERAGES [2080] IRS NUMBER: 834709895 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 11500 WAYZATA BLVD. #1147 CITY: MINNETONKA STATE: MN ZIP: 55305 BUSINESS PHONE: 855-766-9463 MAIL ADDRESS: STREET 1: 11500 WAYZATA BLVD. #1147 CITY: MINNETONKA STATE: MN ZIP: 55305 FORMER COMPANY: FORMER CONFORMED NAME: FRESH GRAPES, LLC DATE OF NAME CHANGE: 20210826 4 1 form4-02212023_040246.xml X0306 4 2023-02-17 0001880343 Fresh Vine Wine, Inc. VINE 0001898426 Novak Damian 11500 WAYZATA BLVD. #1147 MINNETONKA MN 55305 true false true false Common Stock 2023-02-17 4 D 0 250000 0 D 1837672 D The reported securities were forfeited and transferred back to the Issuer without consideration to enable the Issuer to issue shares to a consultant without subjecting the Issuer's other stockholders to dilution therefrom. /s/ Damian Novak 2023-02-21