-----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, JnSwFLK60367hunTTr54rbOj8mXUWBRt8U+T07FqViiuRFp+aUFQGvnv9qMNO7u9 RBxMf8NgKjeGSP9qj5VNPA== 0000901845-04-000008.txt : 20041201 0000901845-04-000008.hdr.sgml : 20041201 20041201164040 ACCESSION NUMBER: 0000901845-04-000008 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041130 FILED AS OF DATE: 20041201 DATE AS OF CHANGE: 20041201 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BURLINGTON COAT FACTORY WAREHOUSE CORP CENTRAL INDEX KEY: 0000718916 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DEPARTMENT STORES [5311] IRS NUMBER: 221970303 STATE OF INCORPORATION: DE FISCAL YEAR END: 0530 BUSINESS ADDRESS: STREET 1: 1830 RTE 130 CITY: BURLINGTON STATE: NJ ZIP: 08016 BUSINESS PHONE: 6093877800 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILSTEIN ANDREW R CENTRAL INDEX KEY: 0000901845 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-08739 FILM NUMBER: 041177887 BUSINESS ADDRESS: STREET 1: C/O BURLINGTON COAT FACTORY WAREHOUSE CO STREET 2: 1830 ROUTE 130 CITY: BURLINGTON STATE: NJ ZIP: 08016 BUSINESS PHONE: 6093877800 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-11-30 0 0000718916 BURLINGTON COAT FACTORY WAREHOUSE CORP BCF 0000901845 MILSTEIN ANDREW R 1830 RT. 130 BURLINGTON NJ 08016 1 1 1 0 Executive V.P. Common Stock, $1.00 Par Value 2004-11-30 4 G 0 13291 0 D 2753360 D Common Stock, $1.00 Par Value 6743984 I by spouse Common Stock, $1.00 Par Value 159246 I see footnote Represents shares in which the reporting person's spouse may be deemed to have an indirect interest. Accordingly, the reporting person may also be deemed to have an indirect interest in such shares. The reporting person disclaims any such interest. Includes 43,928 shares held by the Andrew Milstein Trust and 16,068 shares held by the AHM Trust and 23,322 shares held by the DJM Trust, trusts established for the benefit of the children of Andrew Milstein. Such shares are reported by reason of Rule 16a-1(a)(2)(ii)(A), but Andrew Milstein disclaims any pecuniary interest in such shares. This also includes 75,928 shares owned by Samgray, L.P., a limited partnership. Andrew Milstein, as a member of Latzim Family, LLC (the general partner of Samgray, L.P.) and as a limited partner of Samgray, L.P., has a pecuniary interest in these shares. /s/ Brian Flynn by power of attorney previously filed 2004-12-01 -----END PRIVACY-ENHANCED MESSAGE-----