3 1 form3.txt FORM 3 STATEMENT OF OWNERSHIP OF SECURITIES
------------------ U.S. SECURITIES AND EXCHANGE COMMISSION --------------------------- FORM 3 Washington, D.C. 20549 OMB APPROVAL ------------------ OMB Number: 3235-0104 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 Section 30(f) of the Investment Company Act of 1940 ---------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Persons 2. Date of Event 4. Issuer Name and Ticker or Trading Symbol Requiring Statement (Month/Day/Year) Distinctive Devices, Inc. (DDEV - OTCBB) 03/05/2002 ---------------------------------------------------------------------------------------------------------------------------------- (Last) (First) (Middle) 5. Relationship of Reporting 6. If Amendment, Person to Issuer Date of Original Ammosov Alexander (Check all applicable) (Month/Day/Year) __x__ Director __x__ 10% Owner _____ Officer _____ Other (give title (specify below) below) _________________________________ ---------------------------------------------------------------------------------------------------------------------------------- (Street) 3. IRS or Social 7. Individual or Joint/ Security Number of Group Filing Reporting Person (Check Applicable Line) Distinctive Devices, Inc. (Voluntary) __x__ Form filed by One Bridge Plaza, Suite 100 One Reporting Person ____ Form filed by More than One Reporting Person ---------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) Fort Lee New Jersey 07024 TABLE 1-- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED ---------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amounts of 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Securities Direct (D) or Beneficial Ownership Beneficially Owned Indirect (I) (Instr. 5) (Instr. 4) (Instr. 5) ---------------------------------------------------------------------------------------------------------------------------------- Common Stock, $0.05 par value 500,000 shares D ---------------------------------------------------------------------------------------------------------------------------------- Common Stock, $0.05 par value 1,250,000 shares I ** ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) * If the form is filed by more than one reporting person, see Instruction 5(b)(v).
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ---------------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Date 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of Security (Instr. 4) Exercisable Securities Underlying or Exercise Form of Indirect and Derivative Security Price of Derivative Beneficial Expiration (Instr. 4) Derivative Security: Ownership Date Security Direct (Instr. 5) (D) or (Month/Day/Year) Indirect (I) (Instr. 5) ---------------------- ---------------------- Date Expiration Title Amount or Exercisable Date Number of Shares ---------------------------------------------------------------------------------------------------------------------------------- 10% Convertible Debenture 12/27/ 12/27/ Common Variable* Variable* I ** 2001 2006 Stock, $0.05 par value ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------
EXPLANATION OF RESPONSES: * The Amount of Shares and the Conversion Price Per Share is as follows: Year 1 - 1,600,000 shares at $0.25; Year 2 - 1,066,667 shares at $0.37 1/2; Year 3 - 800,000 shares at $0.50; Year 4 - 640,000 shares at $0.62 1/2; and Year 5 - 533,333 shares at $0.75. ** Securities are owned by Link Assets Limited, a limited liability company of which the reporting person is an affiliate. *** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Alexander Ammosov ----------------------------------- 4/16/02 Alexander Ammosov Date NOTE: FILE THREE COPIES OF THIS FORM, ONE OF WHICH MUST BE MANUALLY SIGNED. IF SPACE PROVIDED 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.