4 1 form4.txt FORM 4 - STATEMENT OF CHANGES IN OWNERSHIP
-------------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 4 WASHINGTON, D.C. 20549 OMB NUMBER: 3235-0287 -------------------------------- EXPIRES: SEPTEMBER 30, 1998 |_| CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB APPROVAL ESTIMATED AVERAGE BURDEN LONGER SUBJECT TO SECTION HOURS PER RESPONSE.........0.5 16. FORM 4 OR FORM 5 FILED PURSUANT TO SECTION 16(A) OF THE ------------------------------ OBLIGATIONS MAY CONTINUE. SECURITIES EXCHANGE ACT OF 1934, SECTION 17(A) SEE INSTRUCTION 1(B). OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 OR SECTION 30(1) OF THE INVESTMENT COMPANY ACT OF 1940 ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Persons 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer (Check all applicable) Distinctive Devices, Inc. (DDEV - OTCBB) x Director x 10% Owner --- --- x Officer (give title Other (specify --- below) --- below) President and CEO --------------------------- ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS or Social 4. Statement for Security Number Month/Year Mody Sanjay S. of Reporting Person (Voluntary) December 2001 ------------------------------------------------------------------------------------------------------------------------------------ (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) One Bridge Plaza, Suite 100 (Month/Year) x Form filed by One Reporting Person --- Form filed by More than One --- Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Fort Lee New Jersey 07024 ------------------------------------------------------------------------------------------------------------------------------------
TABLE 1-- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED 1. Title of Security 2. Transaction 3. Transaction 4. Securities Acquired 5. Amount of 6. Ownership 7. Nature of (Instr. 3) Date (Month/ Code (A) or Disposed of (D) Securities Form: Indirect Day/Year) (Instr. 8) Beneficially Direct (D) Beneficial (Instr. 3, 4, and 5) Owned at End or Indirect Ownership ----------------------------------------- of Month (I) (A) or Code V Amount (D) Price (Instr. 3 (Instr. 4) (Instr. 4) and 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $0.05 par value 12/19/01 K* 150,000 D * 800,000 D ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, $0.05 par value 12/19/01 K* 1,100,000 D * 0 I By Spouse ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (over) * If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1474 (7-96)
FORM 4 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Conversion 3. Transaction 4. Transaction 5. Number of 6. Date 7. Title and Amount (Instr. 3) or Date Code Derivative Exercisable of Underlying Exercise Securities and Securities Price of (Month/Day/ (Instr. 8) Acquired (A) Expiration Derivative Year) or Disposed Date (Instr. 3 and 4) Security of (D) (Month/Day/ (Instr. 3, Year) 4 and 5) ------------------------------------------------------------------------------------------------------------------------------------ Date Expira- Amount or Code V (A) (D) Exer- tion Title Number of cisable Date Shares ------------------------------------------------------------------------------------------------------------------------------------ Series C Preferred Stock 12/19/01 K* 1,000 Common 125,000 Stock, $0.05 par value ------------------------------------------------------------------------------------------------------------------------------------ Series C Preferred Stock 12/19/01 K* 9,000 Common 1,125,000 Stock, $0.05 par value ------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------- 8. Price of 9. Number of 10. Ownership 11. Nature of Derivative Derivative Form of Indirect Security Securities Derivative Beneficial Beneficially Security: Ownership (Instr. 5) Owned at Direct (D) End of Month or (Instr. 4) Indirect (I) (Instr. 4) (Instr. 4) ---------------------------------------------------------------- * 1,000 D ---------------------------------------------------------------- * 9,000 I By Spouse ---------------------------------------------------------------- EXPLANATION OF RESPONSES: *The Change in beneficial ownership did not involve a cash transaction, rather it was an exchange of 1,250,000 shares of Common Stock for 10,000 shares of Series C Preferred, which are identical on a conversion basis to the 1,250,000 shares of Common Stock. **INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS CONSTITUTE by: /s/ Sanjay S. Mody 3/18/02 CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. -------------------------------- -------------- **SANJAY S. MODY DATE 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 SPACED PROVIDED IS INSUFFICIENT, SEE INSTRUCTION 6 FOR PROCEDURE. Potential persons who are to respond to the collection of information contained in this form are Page 2 not required to respond unless the form displays a currently valid OMB Number. SEC 1474 (7-96)