4 1 0001.txt FORM 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL [ ] CHECK THIS BOX IF NO LONGER WASHINGTON, D.C. 20549 OMB NUMBER 3235-0287 SUBJECT TO SECTION 16. FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP EXPIRES:DECEMBER 31, 2001 OR FORM 5 OBLIGATIONS MAY ESTIMATED AVERAGE BURDEN CONTINUE. SEE INSTRUCTION 1(B). HOURS PER RESPONSE.....0.5 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 (PRINT OR TYPE RESPONSES) ---------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Issuer Name AND Ticker or 6. Relationship of Reporting Person(s) to Issuer Trading Symbol (Check all applicable) Director 10% Owner ----- ----- X Officer ----- Other (give title below) (specify below) Evangelou Evangelos Central European Distribution Corporation "CEDC" ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS 4. Statement Identification for Number of Month/Year Reporting Person, if an entity (Voluntary) ul. FOSA 37B M.45 09/2000 ----------------------------------------------------------------------------------------------------------------------------- (Street) 5. If 7. Individual or Joint/Group Filing (Check Applicable Amendment, Line) Date of _X_ Form filed by One Reporting Person Original ___ Form filed by More than One Reporting Person Warsaw Poland 02768 (Month/Year) ------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I-- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. --------------------- -------- ---------- ------------------------------ ----------- ---------- ---------- Amount of Owner- Securities ship Trans- Trans- Securities Acquired (A) Beneficially Form: action action or Disposed of (D) Owned at Direct Nature of Date Code (Instr. 3, 4 and 5) End of (D) or Indirect Title of (Month/ (Instr. 8) ---------------------------- Month Indirect Beneficial Security Day/ ---------- Amount (A) or Price (Instr. (I) Ownership (Instr. 3) Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4) --------------------- -------- ---- ---- ----------- ------ --------- ----------- ---------- ---------- Common Stock 28,200 D ----------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, SEE Instruction 4(b)(v) 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 CURRENTLY VALID OMB CONTROL NUMBER SEC 1472 (3-99)
FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. ---------- -------- -------- -------- ---------- ------------ -------------- ------ ---------- --------- ---------- Title and Ownership Number of Date Exer- Amount of Form of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) ---------- -------- -------- ---- --- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ---------- Central European Distribution Corp. Common Stock $4.00 5/23/00 A 10,000 5/23/00 5/23/10 Common 10,000 39,000 Stock ------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
** Intentional misstatements or omissions of /s/ Evangelos Evangelou 9/26/00 facts constitute Federal Criminal Violations. -------------------------------- ------------ SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) ** Signature of Reporting Person Date
Note: File three copies of this Form, one of which must be manually signed. If space 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 currently valid OMB Number. SEC 1472 (3-99) Page 2