0001437749-14-017929.txt : 20141003 0001437749-14-017929.hdr.sgml : 20141003 20141003141437 ACCESSION NUMBER: 0001437749-14-017929 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141002 FILED AS OF DATE: 20141003 DATE AS OF CHANGE: 20141003 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DEBELAK DONALD S CENTRAL INDEX KEY: 0001528492 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36210 FILM NUMBER: 141139313 MAIL ADDRESS: STREET 1: C/O MORSE ZELNICK ROSE & LANDER LLP STREET 2: 405 PARK AVENUE SUITE 1401 CITY: NEW YORK STATE: NY ZIP: 10022 4 1 rdgdoc.xml FORM 4 X0306 4 2014-10-02 0001307579 LIQTECH INTERNATIONAL INC LIQT 0001528492 DEBELAK DONALD S C/O MORSE ZELNICK ROSE & LANDER LLP 405 PARK AVENUE SUITE 1401 NEW YORK NY 10022 1 President, Liqtech NA Common Stock 2014-10-02 4 P 0 18787 1.54 A 390644 D Includes 142,500 stock options having an exercise price of $3.00 that vested in three equal annual installments on August 24, 2011, September 1, 2012 and September 1, 2013 and 58,399 stock options having an exercise price of $3.28 vesting in three equal annual installments on March 23, 2012, March 23, 2013 and March 23, 2014. /s/ Donald S. Debelak 2014-10-02