-----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, UHSz53YZAFwdQ1JglDStEjRmHvrisDZDQh78gTtZF6ro1ar86Vu/6h20riTmr87I FV5lwpMuFcwRu2mL8UhGOg== 0000912057-97-015228.txt : 19970505 0000912057-97-015228.hdr.sgml : 19970505 ACCESSION NUMBER: 0000912057-97-015228 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970422 FILED AS OF DATE: 19970502 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: USMX INC CENTRAL INDEX KEY: 0000315523 STANDARD INDUSTRIAL CLASSIFICATION: GOLD & SILVER ORES [1040] IRS NUMBER: 841076625 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-09370 FILM NUMBER: 97593911 BUSINESS ADDRESS: STREET 1: 141 UNION BLVD STE 100 CITY: LAKEWOOD STATE: CO ZIP: 80228 BUSINESS PHONE: 3039854665 MAIL ADDRESS: STREET 1: 141 UNION BLVD SUITE 100 CITY: LAKEWOOD STATE: CO ZIP: 80228 FORMER COMPANY: FORMER CONFORMED NAME: U S MINERALS EXPLORATION CO DATE OF NAME CHANGE: 19880222 COMPANY DATA: COMPANY CONFORMED NAME: COOK INLET REGION INC CENTRAL INDEX KEY: 0000024363 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] OWNER IRS NUMBER: 920042304 STATE OF INCORPORATION: AK FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 2525 C STREET CITY: ANCHORAGE STATE: AK ZIP: 99503 BUSINESS PHONE: 907-274-8638 MAIL ADDRESS: STREET 2: 2525 C STREET CITY: ANCHORAGE STATE: AK ZIP: 99503 3 1 FORM 3
- -------- 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 Expires: September 30, 1998 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Estimated average burden Section 17(a) of the Public Utility Holding Company Act of 1935 or hours per response .... 0.5 (Print or Type Responses) Section 30(f) of the Investment Company Act of 1940 ----------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Re- 4. Issuer Name AND Ticker or Trading Symbol quiring Statement COOK INLET REGION, INC. (Month/Day/Year) USMX, INC. (USMX -- Nasdaq) (USM -- Toronto Exchange) - ------------------------------------------------- ------------------------------------------------------------ (Last) (First) (Middle) 04/22/97 5. Relationship of Reporting Person(s) 6. If Amendment, Date ----------------------- to Issuer (Check all applicable) of Original 3. IRS or Social Se- Director X 10% Owner (Month/Day/Year) curity Number of ---- ---- 2525 "C" Street Reporting Person Officer (give Other (specify --------------------- - ------------------------------------------------- (Voluntary) title below) below) 7. Individual or (Street) ---- ---- Joint/Group Filing (Check Applicable Line) --------------------------- Form filed by One X Reporting Person --- Form filed by More than One Reporting Person Anchorage, Alaska 99503 --- - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned Form: Direct Ownership (Instr. 5) (Instr. 4) (D) or Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,540,603 I By North Pacific Mining - ------------------------------------------------------------------------------------------------------------------------------------ Corporation, a wholly-owned - ------------------------------------------------------------------------------------------------------------------------------------ subsidiary - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock (see Explanation) 1,000,000 I By Peak Oilfield Service Company, - ------------------------------------------------------------------------------------------------------------------------------------ a general partnership - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) * If the form is filed by more than one reporting person, SEE Instruction 5(b)(v). SEC 1473 (7-96)
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) cisable and Underlying Derivative Security sion or ship Beneficial Expiration (Instr. 4) Exercise Form of Ownership Date Price of Deriv- (Instr. 5) (Month/Day/ Deri- ative Year) vative Security: -------------------------------------------------- Security Direct Amount (D) or Date Expir- of Indirect Exer- ation Title Number (I) cisable Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: On April 22, 1997, Peak Oilfield Service Company ("Peak"), Dakota Mining Corporation ("Dakota") and USMX, Inc. ("USMX") entered into a binding letter agreement pursuant to which USMX will issue to Peak one million (1,000,000) shares of USMX common stock immediately prior to the consummation of a merger between USMX and a subsidiary of Dakota, provided that said merger is consummated on or prior to June 15, 1997. By: /s/ MARK W. KROLOFF 5/1/97 ------------------------------------- ---------------------- **Intentional misstatements or omissions of facts constitute Federal **Signature of Reporting Person Date Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Its: Vice-President ------------------------------------------ ***On behalf of Cook Inlet Region, Inc. ***In executing and filing this Form 3, Cook Inlet Region, Inc. does not intend to waive the exemption afforded it under 43 U.S.C. Section 1625 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 are not required to respond unless the form displays a currently valid OMB Number. Page 2 SEC 1473 (7-96)
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