-----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, HzDnRbHxnEZNBffdfWKnAMgjyO1CwjHK01iVRaRk5Ew4XGVgUtPt61+mPZr3PWQp RqgwJfaw80Jp9Sf1HWXaDQ== 0001163238-02-000097.txt : 20021211 0001163238-02-000097.hdr.sgml : 20021211 20021211143815 ACCESSION NUMBER: 0001163238-02-000097 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021210 FILED AS OF DATE: 20021211 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: USA VIDEO INTERACTIVE CORP CENTRAL INDEX KEY: 0001107280 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 954370725 STATE OF INCORPORATION: WY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-29651 FILM NUMBER: 02854607 BUSINESS ADDRESS: STREET 1: 837 WEST HASTINGS STREET #507 STREET 2: VANCOUVER BRITISH COLUMBIA CANADA V6C 3 BUSINESS PHONE: 6046851017 MAIL ADDRESS: STREET 1: 837 WEST HASTINGS STREET #507 STREET 2: VANCOUVER BRITISH COLUMBIA CANADA V6C 3 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: MOLLINA EDWIN CENTRAL INDEX KEY: 0001170166 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 70 ESSEX ST CITY: MYSTIC STATE: CT ZIP: 06355 BUSINESS PHONE: 8605721560 MAIL ADDRESS: STREET 1: 70 ESSEX ST CITY: MYSTIC STATE: CT ZIP: 06355 4 1 doc1.txt U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 ( ) Check this box if no longer subject to Section 126. Form 4 or Form 5 obligations may continue. See Instruction 1(b). 1. Name and Address of Reporting Person MOLINA EDWIN ---------------------------------------------------- (Last) (First) (Middle) 84 EAST SHORE ROAD ---------------------------------------------------- (Street) GROTON LONG POINT CONNECTICUT 06340 ---------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol USA VIDEO INTERACTIVE CORP. - OTC BB - "USVO" TSX "US" ------------------------------------------------------------------ 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Day/Year 12/10/02 5. If Amendment, Date of Original (Month/Day/Year) 6. Relationship of Reporting Person to Issuer (Check all applicable) X Director 10% Owner X Officer (Give title below) Other (specify below) President TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
6. Owner- 7. Nature 5. Amount of ship of In- 2. Trans Securities Form: direct action Date 4. Securities Acquired Beneficially Direct Bene- 3. Trans- or Disposed of (D) Owned at (D) or ficial (Month/ action Code (Instr. 3, 4 & 5) End of Indirect Owner- Day/ (Instr. 8) Month (I) ship 1. Title of Security (Instr. 3) Year) Code V Amount (A) or Price (Inst. 3&4) (Inst.4) (Inst.4) (D) - ------------------------------- --------- ------- ----- ------ ----- ------ ------------ -------- ---------- - ------------------------------- --------- ------- ----- ------ ----- ------ ------------ -------- ---------- - ------------------------------- --------- ------- ----- ------ ----- ------ ------------ -------- ---------- - ------------------------------- --------- ------- ----- ------ ----- ------ ------------ -------- ----------
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) 6. Date Exer- 9. 10. 5. cisable 7. Number Owner- Number of and Ex- Title and of ship Deriva piration Amount of Deriv- Form 11. Na- tive Date Underlying 8. ative of De- ture securities (Month/ Securities Price Secur- rivative of In- 2. Conver- Acquired Day/ (Instr.3 of ities Secur- direct sion or 3. Trans- 4. (A) or Year) and 4) Deriva- Bene- ity: Bene- Exercise action Trans- Disposed Date Amount ative fically Direct ficial 1. Title of Price of Date action of (D) Ex- Ex- or Secur- Owned (D) or Owner- Derivative Deriv- (Month/ Code (Instr.3, er- pira- Number ity . at End Indi- ship Security ative Day/ (Instr.8) 4 and 5) cis- tion of (Instr of Month rect (I) (Instr. Instr.3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr.4) (Inst 4) 4) - ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- ------- Options 0.50 12/10/02 H 900,000 01/31/02 01/31/04 Option 900,000 0.50 - 0 - D - ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- ------- - ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- ------- - ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- -------
Explanation of Responses: "Edwin Molina" December 10, 2002 --------------------- ------------------- Signature of Reporting Person Date ** 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. -----END PRIVACY-ENHANCED MESSAGE-----