EzFill Holdings Inc.

01/21/2022 | Press release | Distributed by Public on 01/21/2022 17:30

Initial Statement of Beneficial Ownership (Form 3)

Ownership Submission
FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person *
DeVoe Michael Andrew
2. Date of Event Requiring Statement (Month/Day/Year)
2022-01-11
3. Issuer Name and Ticker or Trading Symbol
EzFill Holdings Inc [EZFL]
(Last) (First) (Middle)
2125 BISCAYNE BLVD
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
Chief Operating Officer /
5. If Amendment, Date Original Filed(Month/Day/Year)
(Street)
MIAMI FL 33137
6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security 2. Amount of Securities Beneficially Owned 3. Ownership Form: Direct (D) or Indirect (I) 4. Nature of Indirect Beneficial Ownership
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security 2. Date Exercisable and Expiration Date 3. Title and Amount of Securities Underlying Derivative Security 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) 6. Nature of Indirect Beneficial Ownership
Date Exercisable Expriation Date Title Amount or Number of Shares

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
DeVoe Michael Andrew
2125 BISCAYNE BLVD

MIAMI, FL33137


Chief Operating Officer

Signatures

/s/ Michael Andrew DeVoe 2022-01-21
**Signature of Reporting Person Date

Explanation of Responses:

(*) If the form is filed by more than one reporting person, see Instruction 5(b)(v).
(**) Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
(1) Mr. DeVoe was appointed Chief Operating Officer of the Issuer on January 11, 2022. Mr. DeVoe was granted a total of 53,571 shares of restricted common stock as a signing bonus ($75,000 value) pursuant to his "Offer Letter." These restricted shares will vest 1/2 on the first anniversary of Mr. DeVoe's employment start date and 1/2 on the second anniversary of Mr. DeVoe's employment start date.
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.