-----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, H14n0gTAan7050zuNZl+pL0HVZmmk8gDwHlZwD6bHrBf8plcsrGE5JTk6YC5t5o3 Xu3kyx5wCp1aepL06clUJw== 0000074925-00-000002.txt : 20000203 0000074925-00-000002.hdr.sgml : 20000203 ACCESSION NUMBER: 0000074925-00-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000126 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ORIGINAL SIXTEEN TO ONE MINE INC /CA/ CENTRAL INDEX KEY: 0000074925 STANDARD INDUSTRIAL CLASSIFICATION: GOLD & SILVER ORES [1040] IRS NUMBER: 940735390 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-10156 FILM NUMBER: 513368 BUSINESS ADDRESS: STREET 1: P O BOX 1621 CITY: ALLEGHENY STATE: CA ZIP: 95910 BUSINESS PHONE: 9162873223 MAIL ADDRESS: STREET 1: PO BOX 1621 STREET 2: PO BOX 1621 CITY: ALLEGHANY STATE: CA ZIP: 95910 COMPANY DATA: COMPANY CONFORMED NAME: ORIGINAL SIXTEEN TO ONE MINE INC /CA/ CENTRAL INDEX KEY: 0000074925 STANDARD INDUSTRIAL CLASSIFICATION: GOLD & SILVER ORES [1040] DIRECTOR IRS NUMBER: 940735390 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: P O BOX 1621 CITY: ALLEGHENY STATE: CA ZIP: 95910 BUSINESS PHONE: 9162873223 MAIL ADDRESS: STREET 1: PO BOX 1621 STREET 2: PO BOX 1621 CITY: ALLEGHANY STATE: CA ZIP: 95910 4 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person MICHAEL M. MILLER P.O. BOX 941 ALLEGHANY, CA 95910 USA 2. Issuer Name and Ticker or Trading Symbol ORIGINAL SIXTEEN TO ONE MINE, INC. OAU 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year: DECEMBER 1999 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting person(s) to Issuer (Check all applicable) (X) Director (X) 10% Owner (X) Officer (give title below) ( ) Other Title: PRESIDENT 7. Individual or Joint/Group Filing (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
________________________________________________________________________________________________________________________ Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ________________________________________________________________________________________________________________________ 1. Title of 2. Transaction 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of Security Date Code or Disposed of (D) Securities Form: In-direct Beneficially Direct (D) Beneficial Month/Day/ Owned at End or Ownership Year Code V Amount (A) or (D) Price of Month Indirect (I) ________________________________________________________________________________________________________________________ Common Stock 12/30/1999 P 76,249 A $0.750 420,999 D N/A ________________________________________________________________________________________________________________________
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) Not Applicable SIGNATURE Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized. ORIGINAL SIXTEEN TO ONE MINE, INC. (Registrant) Michael M. Miller President and Director Dated: January 26, 2000
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