0001144204-11-071319.txt : 20111222
0001144204-11-071319.hdr.sgml : 20111222
20111222212925
ACCESSION NUMBER: 0001144204-11-071319
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111216
FILED AS OF DATE: 20111222
DATE AS OF CHANGE: 20111222
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Burgon Paul
CENTRAL INDEX KEY: 0001480555
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53769
FILM NUMBER: 111278856
MAIL ADDRESS:
STREET 1: 5314 N. RIVER RUN DRIVE, SUITE 350
CITY: PROVO
STATE: UT
ZIP: 84604
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: LIQTECH INTERNATIONAL INC
CENTRAL INDEX KEY: 0001307579
STANDARD INDUSTRIAL CLASSIFICATION: MISC INDUSTRIAL & COMMERCIAL MACHINERY & EQUIPMENT [3590]
IRS NUMBER: 201431677
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: INDUSTRIPARKEN 22C
CITY: BALLERUP
STATE: G7
ZIP: DK-2750
BUSINESS PHONE: 01145 2390 4545
MAIL ADDRESS:
STREET 1: INDUSTRIPARKEN 22C
CITY: BALLERUP
STATE: G7
ZIP: DK-2750
FORMER COMPANY:
FORMER CONFORMED NAME: Blue Moose Media Inc
DATE OF NAME CHANGE: 20041101
4/A
1
form4a.xml
OWNERSHIP DOCUMENT
X0304
4/A
2011-12-16
2011-12-20
0
0001307579
LIQTECH INTERNATIONAL INC
LIQT
0001480555
Burgon Paul
5314 N. RIVER RUN DRIVE, SUITE 350
PROVO
UT
84604
1
0
0
0
Stock options
3.60
2011-12-16
4
A
0
20000
0
A
2014-12-16
Common stock
20000
20000
D
The options vest in three equal annual installments on December 16, 2011, September 1, 2012 and September 1, 2013.
/s/ Paul Burgon
2011-12-22