SEC Form 3
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*
Dalfonsi John

(Last) (First) (Middle)
205 SE DAVIS AVE
SUITE C

(Street)
BEND OR 97702

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/15/2023
3. Issuer Name and Ticker or Trading Symbol
BranchOut Food Inc. [ BOF ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
06/16/2023
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant 06/15/2023 05/26/2027 Common Stock 18,334(1) $7.5(1) I BY EAGLEVISION VENTURES, INC.
Warrant 06/15/2023 06/06/2027 Common Stock 3,394(1) $7.5(1) I BY EAGLEVISION VENTURES, INC.
Warrant 06/15/2023 12/08/2030 Common Stock 15,383(1) $6.5(1) I BY EAGLEVISION VENTURES, INC.
Warrant 06/15/2023 05/07/2031 Common Stock 7,692(1) $7.1(1) I BY EAGLEVISION VENTURES, INC.
Explanation of Responses:
1. Share amounts and exercise price amended to reflect 2.5:1 reverse stock split effective June 16, 2023.
/s/ John Dalfonsi 07/13/2023
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.