3 1 a31338.txt GEORGE HAYWOOD FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities 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 -------- FORM 3 -------- Check box if no longer subject to Section 16. Form 4 or Form 5 obli- gations may continue. |_| -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Date of Event Requiring Statement (Month/Day/Year) Haywood George W. 9/6/01 -------------------------------------------------------------------------------- (Last) (First) (middle) 3. IRS or Social Security Number of Reporting 642 Second Street Person (Voluntary) ------------------------------------------------ (Street) Brooklyn, New York 11215 -------------------------------------------------------------------------------- (City) (State) (Zip) --------------------------------------------------------------------------------
4. Issuer Name and Ticker or Trading Symbol Ambase Corporation (ABCP) -------------------------------------------------------------------------------------------------------- 5. Relationship of Reporting Person(s) to Issuer 6. If Amendment, Date of Original (Month/Day/Year) (check if applicable) -------------------------------------------------- Director X 10% Owner ---- ---- Officer (give Other (specify 7. Individual or Joint/Group Filing ---- title below) ---- below) (check applicable line) X Form Filed by One Reporting Person ---------------------------- ---- Form Filed by More than One Person ---- --------------------------------------------------------------------------------------------------------
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned -------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities Beneficially Owned -------------------------------------------------------------------------------- Common Stock 4,266,500 -------------------------------------------------------------------------------- 356,975 -------------------------------------------------------------------------------- 49,000 -------------------------------------------------------------------------------- 60,000 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------
3. Ownership Form: Direct (D) or Indirect (I) 4. Nature of Indirect Beneficial Ownership ----------------------------------------------------------------------------------------------- D ----------------------------------------------------------------------------------------------- I Owned by children ----------------------------------------------------------------------------------------------- I Owned by spouse ----------------------------------------------------------------------------------------------- I Owned jointly with mother ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------
Reminder Report on a separate line for each class of securities beneficially owned directly or indirecly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). Page 1 of 2 FORM 3 (continued) Table II - Derivative Securties Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) -------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Date Exercisable 3 Title and Amount of Securities Underlying Derivative Security Security and Expiration Date -------------------------------------------------------------------------------------- Date Expir- Title Amount or Exer- ation Number of cisble Date Shares -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------- 4. Con- 5. Ownership 6. Nature of Indirect version or Form of De- Beneficial Ownership Exercise rivative Price of Security Derivative Direct Security (D) or Indirect (I) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------
Explanation of Responses: /s/ George W. Haywood September 17, 2001 ----------------------------- -------------------- Signature of Reporting Person Date
** Intentional misstatements or omissins 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 is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form ane not required to respond unless the form displays a currently valid OMB Number. Page 2 of 2