| 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, 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/31/2009 |
3. Issuer Name and Ticker or Trading Symbol
DAIS ANALYTIC CORP [ DLYT ] |
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| 4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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) |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities) |
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| 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 | ||||
| 50,000 9% note | 12/11/2007 | 09/11/2009 | Dais Common | 279,281 | 0.2 | D | |
| 5-year Warrants, $.25 | 12/11/2007 | 12/11/2012 | Dais Common | 250,000 | 0.25 | D | |
| $50,000 9% Note | 12/20/2007 | 12/20/2009 | Dais Common | 278,726 | 0.2 | D | |
| 5-year Warrants, $.25 | 12/20/2007 | 12/20/2012 | Dais Common | 250,000 | 0.25 | D | |
| $50,000 9% Note | 12/31/2007 | 09/30/2009 | Dais Common | 278,048 | 0.2 | D | |
| 5-year Warrants, $.25 | 12/31/2007 | 12/31/2012 | Dais Common | 250,000 | 0.25 | D | |
| $25,000 9% Note | 01/21/2008 | 10/21/2009 | Dais Common | 138,377 | 0.2 | D | |
| 5-year Warrants, $.25 | 01/21/2008 | 01/21/2013 | Dais Common | 125,000 | 0.25 | D | |
| $300000 9% Note | 12/20/2007 | 09/20/2009 | Dais Common | 1,672,356 | 0.2 | D | |
| 5-year Warrants, $.25 | 12/20/2007 | 12/20/2012 | Dais Common | 1,500,000 | 0.25 | D | |
| $250000 9% Note | 12/31/2007 | 09/30/2009 | Dais Common | 1,390,240 | 0.2 | D | |
| 5-year Warrants, $.25 | 12/31/2007 | 12/31/2012 | Dais Common | 1,250,000 | 0.25 | D | |
| Explanation of Responses: |
| Remarks: |
| Leah Kaplan-Samuels, my wife, is filing jointly with me, has a joint interest in 875,000 warrants and $175,000 of original principal note value of the notes. The $250,000 and $300,000 notes were issued to an IRA in Leonard Samuels name only. All the notes earn interest at 9%, and principal and interest are convertible into stock at the conversion price. Amount of securities underlying is as of 3/31/09. |
| Leonard Samuels | 05/06/2009 | |
| ** 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. | ||