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