-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Upu/+NbH3LgdvTHJa4q1raDblcOoa3eDnrSPcenJ9p+vYlBUvCGWs6WI7jX2n1O2 MHqeEUEEqUMaIRO6J/ubrQ== 0001140361-10-027739.txt : 20100701 0001140361-10-027739.hdr.sgml : 20100701 20100701120134 ACCESSION NUMBER: 0001140361-10-027739 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20100629 FILED AS OF DATE: 20100701 DATE AS OF CHANGE: 20100701 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lazar Terry CENTRAL INDEX KEY: 0001411926 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09478 FILM NUMBER: 10929584 MAIL ADDRESS: STREET 1: C/O WATER CHEF, INC. STREET 2: 68 SOUTH SERVICE ROAD, SUITE 100 CITY: MELVILLE STATE: NY ZIP: 11747 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PureSafe Water Systems, Inc. CENTRAL INDEX KEY: 0000764839 STANDARD INDUSTRIAL CLASSIFICATION: REFRIGERATION & SERVICE INDUSTRY MACHINERY [3580] IRS NUMBER: 860515678 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7707 EAST ACOMA DRIVE SUITE 109 CITY: SCOTTSDALE STATE: AZ ZIP: 85260 BUSINESS PHONE: 6029914534 MAIL ADDRESS: STREET 1: 1007 GLEN COVE AVE. CITY: GLEN HEAD STATE: NY ZIP: 11030 FORMER COMPANY: FORMER CONFORMED NAME: WATER CHEF INC DATE OF NAME CHANGE: 19930813 FORMER COMPANY: FORMER CONFORMED NAME: AUTO SWAP USA INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: INTERMARK GAMING INTERNATIONAL INC/DE/ DATE OF NAME CHANGE: 19911106 4 1 doc1.xml FORM 4 X0303 4 2010-06-29 0 0000764839 PureSafe Water Systems, Inc. PSWS 0001411926 Lazar Terry 25 FAIRCHILD AVE. SUITE 250 PLAINVIEW NY 11803 1 1 0 0 Chief Financial Officer Common Stock 2010-06-29 4 P 0 10000 0.13 A 13306912 D Common Stock 616191 I See Footnote Warrants 0.06 2010-10-21 4 P 0 100000 0 A 2009-10-21 2019-10-21 Common Stock 100000 0 D Warrants Stock 95238 0 D In addition, Mr. Lazar owns beneficially 476,191 shares of reason of his 1/3 ownership in LST Partners which owns such shares directly, and 140,00 shares held by his wife's IRA. Mr. Lazar owns benefically warrants to purchase 95,238 shares of common stock by reason of his 1/3 ownership in LST Partners, which owns such warrants directly. /s/ Terry Lazar 2010-07-01 -----END PRIVACY-ENHANCED MESSAGE-----