8-A12G 1 medina8a12g_mar282002.txt FORM 8-A Securities and Exchange Commission Washington, D.C. 20549 For registration of certain classes of securities pursuant to section 12(b) or (g) of the Securities Exchange Act of 1934 Medina Coffee, Inc. ------------------- (Exact name of registrant as specified in its charter) Nevada 88-0442833 ------ ------------ (State of Incorporation or Organization) (I.R.S. Employer Identification No.) 401 Detwiller Lane, Bellevue, Washington 98004 ---------------------------------------------- (Address of principal executive offices)(Zip Code) Securities to be registered' pursuant to Section 12(b) of the Act: Title of each class Name of each exchange on which to be so registered each class is to be registered -------------------- ------------------------------ NONE NONE If this form relates to the registration of a class of securities pursuant to Section 12(b) of the Exchange Act and is effective pursuant to General Instruction A.(c), check the following box. [ ] If this form relates to the registration of a class of securities pursuant to Section 12(g) of the Exchange Act and is effective pursuant to General Instruction A.(d), check the following box. [X] Securities Act registration statement file number to which this form relates: 333-41124 (if applicable) --------- COMMON STOCK, $0.001 PAR VALUE PER SHARE ---------------------------------------- (Title of class) Information required in registration statement -------------------------------------------------------------------------------- Item 1. Description of Registrant's Securities to be Registered. This registration statement relates to the Common Stock, $.001 par value, of Medina Coffee, Inc. a Nevada corporation (the "Registrant"). A description of the Registrant's Common Stock is set forth under the caption "DESCRIPTION OF SECURITIES" contained in the prospectus included in the Registrant's Registration Statement on Form SB-1 under the Securities Act of 1933 and all amendments thereto, file number 333-41124, declared effective on February 14, 2002. Such prospectus is incorporated herein by reference. Item 2. Exhibits. List below are all exhibits filed as a part of the registration statement: 3.1* Certificate of Incorporation of the Registrant. 3.2* Bylaws of the Registrant. 4.1* Form of Common Stock Certificate. * Previously filed with the Company's Form SB-1, file number 333-41124 and incorporated by reference herein. -------------------------------------------------------------------------------- Signature Pursuant to the requirements of Section 12 of the Securities Exchange Act of -------------------------- 1934 , the registrant has duly caused this registration statement to be signed ---- on its behalf by the undersigned, thereto duly authorized. MEDINA COFFEE, INC. Date: March 21, 2002 By: /s/ Harry Miller -------------- ----------------------------------- Harry Miller, President & Secretary --------------------------------------------------------------------------------