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, 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*
SAMUELS LEONARD

(Last) (First) (Middle)
1101 CENTENNIAL ROAD

(Street)
PENN VALLEY PA 19072

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/31/2009
3. Issuer Name and Ticker or Trading Symbol
DAIS ANALYTIC CORP [ DLYT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
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
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).
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