Sec Form 3 Filing - Sod Jacob @ EzFill Holdings Inc - 2021-09-14

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Sod Jacob
2. Issuer Name and Ticker or Trading Symbol
EzFill Holdings Inc [ EZFL]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
14 WALL STREET, SUITE 2064
3. Date of Earliest Transaction (MM/DD/YY)
09/14/2021
(Street)
NEW YORK, NY10005
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/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 Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 6,287,525 I LH MA 2 LLC and Crestview 360 Holdings LLC ( 1 ) ( 2 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) $ 1.35 07/09/2019 07/09/2024 Common Stock 7,440 I LH MA 2 LLC ( 3 )
Stock Option (right to buy) $ 1.35 07/12/2019 07/12/2024 Common Stock 7,440 I LH MA 2 LLC ( 3 )
Stock Option (right to buy) $ 1.35 07/29/2019 07/29/2024 Common Stock 7,440 I LH MA 2 LLC ( 3 )
Stock Option (right to buy) $ 1.35 12/05/2019 12/05/2024 Common Stock 3,720 I LH MA 2 LLC ( 3 )
Stock Option (right to buy) $ 0.62 12/24/2019 12/24/2024 Common Stock 3,720 I LH MA 2 LLC ( 3 )
Stock Option (right to buy) $ 0.62 01/17/2020 01/17/2025 Common Stock 7,440 I LH MA 2 LLC ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Sod Jacob
14 WALL STREET, SUITE 2064
NEW YORK, NY10005
X
Signatures
/s/ Jacob Sod 09/14/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Jacob Sod is the Manager of LH MA 2 LLC and beneficially owns 5,980,657 shares of common stock held by LH MA 2 LLC.
( 2 )Jacob Sod is the Manager of Crestview 360 Holdings LLC and beneficially owns 306,868 shares of common stock held by Crestview 360 Holdings LLC.
( 3 )Jacob Sod is the Manager of LHA MA 2 LLC and beneficially owns the options and underlying shares held by LHA MA 2 LLC.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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