-----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, HaTYUU4AezbVwxyPjQ0ua8LESJPrp6RQYmoOdeTqSjAp8Wa2KT9z+4Uj/au9/LNA DcfEfGrxL8CI93Lk8BMP+g== 0000914121-99-001199.txt : 19991209 0000914121-99-001199.hdr.sgml : 19991209 ACCESSION NUMBER: 0000914121-99-001199 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991122 FILED AS OF DATE: 19991208 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: OFFICIAL PAYMENTS CORP CENTRAL INDEX KEY: 0001094998 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 522190781 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-28187 FILM NUMBER: 99770718 BUSINESS ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BOULEVARD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 BUSINESS PHONE: 9258387996 MAIL ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BOULEVARD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 FORMER COMPANY: FORMER CONFORMED NAME: US AUDIOTEX CORP DATE OF NAME CHANGE: 19990914 COMPANY DATA: COMPANY CONFORMED NAME: BELTON BRAD CENTRAL INDEX KEY: 0001100618 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BLVD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 MAIL ADDRESS: STREET 1: 2333 SAN RAMON VALLEY BLVD STREET 2: SUITE 450 CITY: SAN RAMON STATE: CA ZIP: 94583 3 1 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP - ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 3 Washington, D.C. 20549 OMB Approval - ------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES ------------------------------ OMB Number: 3235-0104 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Expires: December 31, 2001 Section 17(a) of the Public Utility Holding Company Act of 1935 or Estimated average burden Section 30(f) of the Investment Company Act of 1940 hours per response.......0.5 ------------------------------
(Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer name and Ticker or Trading Symbol Statement (Month/Day/Year) 11/22/99 Official Payments Corporation, OPAY Belton, Brad ----------------------------------------------------------------------------------------- ------------------------------------ 3. I.R.S. Identification 5. Relationship of Reporting 6. If Amendment, Date of (Last) (First) (Middle) Number of Reporting Person(s) to Issuer Original Person, if an entity (Check all applicable) (Month/day/Year) 2333 San Ramon Valley Boulevard, (Voluntary) Suite 450 [ ] Director ------------------------------------ [X] Officer ---------------------------- (Street) (give title below) 7. Individual or Joint/Group [ ] 10% Owner Filing [ ] Other (Check Applicable Line) San Ramon, CA 94583 (specify below) [X] Form Filed by One ------------------------------------ Reporting Person (City) (State) (Zip) Vice President, Engineering [ ] 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 Form: Direct (D) 4. Nature of Indirect (Instr. 4) Beneficially Owned or Indirect (I) (Instr. 5) Beneficial Ownership (Instr. 4) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $0.01 400 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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 Page 1 of 2 SEC 1473 (3-99)
FORM 3 (CONTINUED) TABLE II-- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of 2. Date Exer- 3. Title and Amount of 4. Conversion or 5. Ownership 6. Nature of Derivative cisable and Securities Underlying Exercise Price Form of Indirect Security Expiration Derivative Security of Derivative Derivative Beneficial (Instr. 4) Date (Instr. 4) Security Security: Ownership (Month/Day/Year) Direct (D) or (Instr. 5) Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Date Expira- Title Amount or Exer- tion Number of cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option Immed. 8/30/09 Common Stock, 85,716 $1.33 D (right to buy) (1) par value $0.01 - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option Immed. 9/29/09 Common Stock, 20,232 $1.33 D (right to buy) (1) par value $0.01 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) THE OPTION VESTS IMMEDIATELY UPON THE INITIAL PUBLIC OFFERING, OR NOVEMBER 29, 1999. ** 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 /s/ Brad Belton 12/8/99 signed. If space is insufficient, see Instruction 6 for ------------------------------------ ------------------- procedure. ** Signature of Reporting Person Date 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. Page 2 of 2 SEC 1473 (3-99)
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