3 1 d3.txt FORM 3 ---------------------------- OMB APPROVAL ---------------------------- OMB Number: 3235-0104 Expires: December 31, 2001 Estimated average burden hours per response.......0.5 ---------------------------- -------- 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(f) of the Investment Company Act of 1940 (Print or Type Responses) ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol Requiring Statement Roberts Richard S. (Month/Day/Year) Central European Distribution Corporation (CEDC) 7/2/02 ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. I.R.S. Identification 5. Relationship of Reporting Person(s) to Issuer Number of Reporting (Check all applicable) 21361 Clappertown Dr. Person, if an entity ---------------------------------------------- (voluntary) X Director _______ 10% Owner (Street) --- . Officer (give ______ Other (specify Ashburn VA 20147 --- title below) below) ---------------------------------------------- (City) (State) (Zip) 6. If Amendment, Date of 7. Individual or Joint/Group ---------------------------------------------- Original (Month/Day/Year) 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 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Ownership (Instr. 4) Beneficially Owned Form: Direct (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr.5) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ No Securities Owned ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
(Over) SEC 1473 (3-99) 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). 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 FORM 3 (continued)
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conversion 5. Ownership 6. Nature of Indirect Security cisable and Underlying Derivative Security or Form of Beneficial (Instr. 4) Expiration (Instr. 4) Exercise Derivative Ownership Date Price of Security: (Instr. 5) (Month/Day/ Derivative Direct (D) Year) Security or ----------------------- --------------------------- Indirect Date Expira- Amount (I) Exer- tion Title or (Instr. 5) cisable Date Number of Shares ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Richard S. Roberts 8/2/02 ----------------------------------------------- **Signature of Reporting Person Date 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 currently valid OMB Number. Page 2