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*
SOKOLOFF JONATHAN D

(Last) (First) (Middle)
11111 SANTA MONICA BOULEVARD
SUITE 2000

(Street)
LOS ANGELES CA 90025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/27/2005
3. Issuer Name and Ticker or Trading Symbol
DOLLAR FINANCIAL CORP [ DLLR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X 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)
Common Stock, par value $0.001 per share 7,223,290(1) I By Green Equity Investors II, L.P.(2)
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
Explanation of Responses:
1. Prior to consummation of the Issuer's initial public offering of its common stock, par value $0.001 per share (the "Common Stock"), the Common Stock will undergo a 555-for-1 split. The amount of securities beneficially owned by the reporting person reported on this Form 3 reflects the number of shares of Common Stock that the reporting person will beneficially own upon consummation of the stock split.
2. Green Equity Investors II, L.P. ("GEI") is the direct owner of 7,223,290 shares of Common Stock of the Issuer (the "Shares"). Jonathan D. Sokoloff is a director of the Issuer and a partner of Leonard Green & Partners, L.P., the management company of GEI. Mr. Sokoloff, directly (whether through ownership or position) or indirectly through one or more intermediaries, may be deemed for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, to be an indirect beneficial owner of the Shares owned by GEI and, therefore, a "ten percent holder" hereunder. Mr. Sokoloff disclaims beneficial ownership of the Shares reported herein, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that Mr. Sokoloff is the beneficial owner of such securities for purposes of Section 16 or for any other purposes.
Remarks:
Exhibit List: Exhibit 24 -- Power of Attorney
/s/ Jonathan D. Sokoloff 01/27/2005
** 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.
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