-----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, N1PeG5AmOMEoJv/kF+A5p2wsfNWVE7v/WxlWR4HoUT1TZ+aaERRA6CzmU/8MznHj 05I3YsbN3niveFhoBr/hTg== 0000950148-99-001579.txt : 19990708 0000950148-99-001579.hdr.sgml : 19990708 ACCESSION NUMBER: 0000950148-99-001579 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990524 FILED AS OF DATE: 19990707 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: DISCOVERY INVESTMENTS INC CENTRAL INDEX KEY: 0001083459 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 88049151 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-26175 FILM NUMBER: 99660228 BUSINESS ADDRESS: STREET 1: 2980 S RAINBOW BLVD STREET 2: SUITE 108 CITY: LAS VEGAS STATE: NV ZIP: 89102 BUSINESS PHONE: 7022481047 MAIL ADDRESS: STREET 1: 2980 S RAINBOW BLVD STREET 2: SUITE 108 CITY: LAS VEGAS STATE: NV ZIP: 89102 COMPANY DATA: COMPANY CONFORMED NAME: JACK KIMBERLY LYNN CENTRAL INDEX KEY: 0001088911 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] DIRECTOR STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 2980 S RAINBOW BLVD STREET 2: SUITE 108 CITY: LAS VEGAS STATE: NV ZIP: 89102 BUSINESS PHONE: 7022481047 MAIL ADDRESS: STREET 1: 2980 S RAINBOW BLVD STREET 2: SUITE 108 CITY: LAS VEGAS STATE: NV ZIP: 89102 3 1 FORM 3(KIMBERLY L. JACK) 1 - -------- ------------------------------ FORM 3 OMB APPROVAL - -------- ------------------------------ OMB Number: 3235-0104 Expires: September 30, 1998 Estimated average burden hours per response ...... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 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* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Jack Kimberly Lynn Statement Trading Symbol of Original - ---------------------------------------- (Month/Day/Year) DISCOVERY INVESTMENTS, INC (Month/Day/Year) (Last) (First) (Middle) July 26, 1999 ---------------------------------- 1916 East 50th South ---------------------------- 5. Relationship of Reporting ----------------------- - ---------------------------------------- 3. IRS or Social Security Person to Issuer 7. Individual or Joint/ (Street) Number of Reporting (Check all applicable) Group Filing (Check Wichita Kansas 67216 Person (Voluntary) X Director X 10% Owner applicable line) - -------------------------------------- ----- ----- X Form filed by (City) (State) (Zip) ---------------------------- X Officer Other ----- One Reporting ----- (give ----- (specify Person title below) below) Form filed by ----- More than One ---------------------------------- Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 4) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK $.001 550,000 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. (Over) (Print or Type Responses) (8/96)
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security ------------------------------------------------- Direct Date Expira- Amount or (D) or Exercis- tion Title Number Indirect (I) able Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ KIMBERLY L. JACK July 6, 1999 **Intentional misstatements or omissions of 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. Page 2 If space provided is insufficient, See Instruction 6 for procedure. (8/96) (Print or Type Responses)
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