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 12/31/02 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) Common Shares 12/31/02 P 275,000 A 0.064 4,949,424 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) ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- ------- Warrants 0.064 12/31/02 P 275,000 12/31/02 12/31/04 Common 275,000 0.064 - 0 - D ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- ------- ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- ------- ------------ -------- -------- --- --- ----- ------ ------- ------- ------ ------ ------ -------- ------- -------
Explanation of Responses: "Edwin Molina" January 2, 2003 --------------------- ------------------- 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.