-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, FG/n4x2z6l03NpAs5TjbRjc0u7jsoolXCYjFFGjbn1DOTQj9iVzOSvQEEctiCM9c MVUQrIpQOaRPc4iudCvtDw== 0001179110-03-009416.txt : 20031029 0001179110-03-009416.hdr.sgml : 20031029 20031029091500 ACCESSION NUMBER: 0001179110-03-009416 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031028 FILED AS OF DATE: 20031029 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DAHLBERG K JEFFREY CENTRAL INDEX KEY: 0000938452 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21625 FILM NUMBER: 03962285 BUSINESS ADDRESS: STREET 1: 4200 DAHLBERG DRIVE CITY: MINNEAPOLIS STATE: MN ZIP: 55422 MAIL ADDRESS: STREET 1: GROW BIZ INTERNATIONAL INC STREET 2: 4200 DAHLBERG DRIVE CITY: MINNEAPOLIS STATE: MN ZIP: 55422-4837 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FAMOUS DAVES OF AMERICA INC CENTRAL INDEX KEY: 0001021270 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 411782300 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7657 ANAGRAM DR CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: 612-557-57 MAIL ADDRESS: STREET 1: 7657 ANAGRAM DR CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 4 1 edgar.xml FORM 4 - X0201 4 2003-10-28 0 0001021270 FAMOUS DAVES OF AMERICA INC DAVE 0000938452 DAHLBERG K JEFFREY 1040 HIGH LAKE VIEW COLORADO SPRINGS CO 80906 1 0 0 0 Common Stock, $.01 par value 2003-10-28 4 P 0 7500 4.93 A 272800 D Director Stock Option 4 2011-02-28 Common Stock 50000 50000 D Director Stock Option 8.07 2003-05-23 2012-05-23 Common Stock 5000 5000 D Director Stock Option 4.16 2004-06-13 2013-06-13 Common Stock 5000 5000 D Pursuant to Rule 16b-3 (right to buy). Options vest as follows: 16,667 shares on 2/28/02, 16,667 shares on 2/28/03 and 16,666 shares on 2/28/04. s/ K Jeffrey Dahlberg 2003-10-28 -----END PRIVACY-ENHANCED MESSAGE-----