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 --- --- Officer (give title Other (specify --- below) --- below) President and CEO --------------------------- ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. IRS or Social 4. Statement for Security Number Month/Year Mehta Shrikant of Reporting Person (Voluntary) August 2002 ------------------------------------------------------------------------------------------------------------------------------------ (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of Original (Check Applicable Line) Combine International - 354 Indusco Court (Month/Year) x Form filed by One Reporting Person --- Form filed by More than One --- Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) Troy Michigan 48083 ------------------------------------------------------------------------------------------------------------------------------------
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 08/06/02 P/K* 21,666,666* A * 21,816,666 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (over) (Print or Type Responses) 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 D Preferred Stock 08/06/02 P/K* 173,333 ** Common 21,666,666 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) ---------------------------------------------------------------- $3.75 173,333 D ---------------------------------------------------------------- ---------------------------------------------------------------- ---------------------------------------------------------------- ---------------------------------------------------------------- EXPLANATION OF RESPONSES: *These shares are underlying the Series D Preferred Stock, which is convertible subject to shareholder approval. ** Following the approval by the Company's shareholders of an amendment to the Certificate of Incorporation increasing the number of authorized shares of Common Stock to a number sufficient for conversion of all of the outstanding shares of Series D Preferred Stock into authorized but unissued shares of Common Stock and reducing the par value of the Common Stock to $.01 per share (the "Charter Amendment"), and effective on the date that the Charter Amendment is filed with the New York Secretary of State, each outstanding share of Series D Preferred Stock shall automatically be converted into shares of Common Stock at the rate of one hundred and twenty five (125) shares of Common Stock for each one (1) share of Series D Preferred Stock, subject to certain adjustments, such as a stock split (forward or reverse), stock dividend, reorganization, recapitalization or other event affecting the Common Stock or the Series D Preferred Stock. ***INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS CONSTITUTE CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. by: /s/ Shrikant Mehta 8/30/02 -------------------------------- -------------- ***SHRIKANT MEHTA 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)