3 1 mellonform3.txt MELLON VENTURES INITIAL STATEMENT Form 3 U.S. 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(f) of the Investment Company Act of 1940 -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Mellon Ventures, L.P. -------------------------------------------------------------------------------- (Last) (First) (Middle) 919 North Market Street ---------------------------------------- (Street) Wilmington DE 19801 ---------------------------------------- (City) (State) (Zip) -------------------------------------------------------------------------------- 2. Date of Event Requiring Statement (Month/Day/Year) 02/20/02 -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an entity 25-1779945 -------------------------------------------------------------------------------- 4. Issuer Name and Ticker or Trading Symbol Carrizo Oil & Gas, Inc. (CRZO) -------------------------------------------------------------------------------- 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director 10% Owner Officer (give) X(1) Other (specify title below) below) -------------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable List) Form filed by One Reporting Person X Form filed by More than One Reporting Person ------------------------------------------------------------- Table I - Non-Derivative Securities, Beneficially Owned ------------------------------------------------------------- 1. Title of 2. Amount of Securities 3. Ownership Form: 4. Nature of Security Beneficially Owned Direct (D) or Indirect Beneficial (Instr. 4) (Instr. 4) Indirect (I) Ownership (Instr.5) (Instr. 5) -------------------------------------------------------------------------------- Common Stock, par value $.01 per share 363,636(2) D *If the form is filed by more than one reporting person,see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Response) (over) FORM 3 (Continued)
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative 2. Date Exercisable 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature Security (Instr. 4) and Expiration Underlying Derivative or Exercise Form of of Indirect Date Securities (Instrs. 4) Price of Derivative Beneficial (Month/Day/Year) Derivative Security: Ownership Date Expir- Title Amount or Security Direct (D) (Instr. 5) Exer- ation Number of or Indirect (I) cisable Date Shares Warrant to purchase Common Stock Immed. 12/15/07 Common Stock 276,019(2)(3) $2.20 D Warrant to purchase Common Stock Immed. 02/20/07 Common Stock 168,421(2)(4) $5.94 D Series B Convertible Preferred Participating Stock, par value $0.01 per share Immed. Common Stock 701,754.39(2)(5) $5.70 D
Explanation of Responses: (1) Mellon Ventures, L.P., a Delaware limited partnership ("Mellon Ventures"), may be deemed to be a member of a Section 13(d) group that beneficially owns more than 10% of the issuer's outstanding Common Stock. Mellon Ventures disclaims beneficial ownership of all securities other than those reported above, and this report shall not be deemed an admission that the reporting persons are the beneficial owner of the securities of such group for purposes of Section 16 or for any other purpose. (2) This statement on Form 3 is being filed by Mellon Ventures, MVMA, L.P., a Delaware limited partnership, and MVMA, Inc., a Delaware corporation. MVMA, L.P., is the general partner of Mellon Ventures and holds a 1% equity interest in Mellon Ventures. Its principal business is to act as general partner of Mellon Ventures. MVMA, Inc. is the general partner of MVMA, L.P. and holds a 1% equity interest in MVMA, L.P. Its principal business is to act as general partner of MVMA, L.P. Mellon Bank, N.A., is the majority limited partner of Mellon Ventures. Mellon Financial Corporation is the sole stockholder of Mellon Bank, N.A. (3) The warrant is initially exercisable into shares of Common Stock at an exercise price of $2.20 per share, subject to adjustment. (4) The warrant is initially exercisable into shares of Common Stock at an exercise price of $5.94 per share, subject to adjustment. (5) The reporting persons beneficially own 40,000 shares of Series B Convertible Participating Preferred Stock, each share of which is convertible into shares of Common Stock at a conversion ratio equal to the quotient of $100 divided by the conversion price of the Series B Convertible Participating Preferred Stock. The conversion price is initially $5.70 per share, subject to adjustment. MELLON VENTURES, L.P. By: MVMA, L.P., its general partner By: MVMA, Inc., its general partner By:/s/ Ronald J. Coombs March 4, 2002 ------------------------ ------------- Name: Ronald J. Coombs Date Title: Vice President and Director ** 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 provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a current valid OMB Number. Attachment 1 Joint Filer Information Additional Reporting Persons ---------------------------- MVMA, L.P. 919 North Market Street Wilmington, DE 19801 MVMA, Inc. 919 North Market Street Wilmington, DE 19801 Designated Filer: Mellon Ventures, L.P. ---------------- Issuer & Ticker Symbol: Carrizo Oil & Gas, Inc. (CRZO) ---------------------- Date of Event Requiring Statement: 2/20/02 --------------------------------- Dated: March 4, 2002 MVMA, L.P. by MVMA, Inc., its general partner By:/s/ Ronald J. Coombs ----------------------------------- **Signature of Reporting Person Name: Ronald J. Coombs Title: Vice President and Director MVMA, INC. By:/s/ Ronald J. Coombs ----------------------------------- **Signature of Reporting Person Name: Ronald J. Coombs Title: Vice President and Director