-----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, DpS8rDCdNMmLrDRZy+izmX/RiamSjXaFE8IQ9MRuxhCrhVN4pj7E7O7unMEofuC5 ns/i9T5UC/pKL3+JFUqlbw== 0000950147-03-000101.txt : 20030204 0000950147-03-000101.hdr.sgml : 20030204 20030204172137 ACCESSION NUMBER: 0000950147-03-000101 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030204 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BLOY DEBBIE CENTRAL INDEX KEY: 0001207671 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 5 MAIL ADDRESS: STREET 1: 6363 E CACTUS WREN RD CITY: PHOENIX STATE: AZ ZIP: 85253 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MAIN STREET & MAIN INC CENTRAL INDEX KEY: 0000847466 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 112948370 STATE OF INCORPORATION: DE FISCAL YEAR END: 1228 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18668 FILM NUMBER: 03539255 BUSINESS ADDRESS: STREET 1: 5050 NORTH 40TH ST STREET 2: STE 200 CITY: PHOENIX STATE: AZ ZIP: 85018 BUSINESS PHONE: 6028529000 MAIL ADDRESS: STREET 1: 5050 NORTH 40TH ST STREET 2: STE 200 CITY: PHOENIX STATE: AZ ZIP: 85018 FORMER COMPANY: FORMER CONFORMED NAME: ASSETRONICS INC DATE OF NAME CHANGE: 19900702 5 1 e-9483.txt FORM 5 FOR DEBRA BLOY ------------------------------ OMB APPROVAL ------------------------------ - ------ OMB Number: 3235-0362 FORM 5 Expires: January 31, 2005 - ------ Estimated average burden hours per response ....... 1.0 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [ ] Check this box if no longer subject of Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Report [ ] Form 4 Transactions Reported ================================================================================ 1. Name and Address of Reporting Person* BLOY DEBRA - -------------------------------------------------------------------------------- (Last) (First) (Middle) 6363 EAST GOLD DUST ROAD - -------------------------------------------------------------------------------- (Street) PARADISE VALLEY ARIZONA 85258 - ------------------------------------------------------------------------------ (City) (State) (Zip) ================================================================================ 2. Issuer Name and Ticker or Trading Symbol MAIN STREET AND MAIN INCORPORATED ================================================================================ 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) ================================================================================ 4. Statement for Month/Year DECEMBER 2002 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X Director [ ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) ------------------------------------ ================================================================================ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by One Reporting Person [ ] Form filed by More Than one Reporting Person ================================================================================ Page 1 of 3 Form 5 (continued) Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
========================================================================================================================== | | | | Amount | | | | | | of | | | | | Securities | Secur- | | Nature | | | Acquired (A) | ities | Owner- | of | | | or Disposed | Bene- | ship | Indirect | | | of (D) (Instr. | ficially | Form: | Bene- | | | 3, 4 and 5) | Owned at | Direct | ficial | | | ---------------- | End | (D) or | Owner- | Transaction | Transaction | |(A)| | of Year | Indirect | ship Title of Security | Date | Code | Amount|or |Price | (Instr. | (I) | (Instr. (Instr. 3) | (mm/dd/yy) | (Instr. 8) | |(D)| | 3 and 4) | (Instr.4)| 4) - -------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- ==========================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). PERSONS WHO RESPOND TO THE COLLECTION OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER. Page 2 of 3 Form 5 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
========================================================================================================================= | | | |Number | | | | Number |Owner-| | | | |of | | | | of |ship | | | | |Deriv- | |Title and | | Deriv- |of | |Conver-| | |ative | |Amount of | | ative |Deriv-| |sion | | |Secur- | |Underlying | | Secur- |ative |Nature |oR | | |ities | |Securities | | ities |Secur-|of |Exer- | | |Acquired |Date |(Instr. 3 |Price | Bene- |ity: |In- |cise | | |(A) or |Exercisable and |and 4) |of | ficially|Direct|direct |Price |Trans- | |Disposed |Expiration Date |-------------|Deriv- | Owned |(D) or|Bene- |of |action |Trans- |of(D) |(Month/Day/Year) | |Amount|ative | at End |In- |ficial Title of |Deriv- |Date |action |(Instr.3,|-----------------| |or |Secur- | of |direct|Owner- Derivative |ative |(Month/ |Code |4 and 5) |Date | Expira-| |Number|ity | Year |(I) |ship Security |Secur- |Day/ |(Instr.|-------- |Exer- | tion | |of |(Instr.| (Instr. |(Instr|(Instr. (Instr. 3) |ity |Year) |8) |(A) | (D)|cisable | Date |Title |Shares|5) | 4) |4) |4) - ------------------------------------------------------------------------------------------------------------------------- DIRECTOR STOCK $4.16 07-22-02 A 5000 07-22-02 07-21-12 COMMON 5000 5,000 D OPTION (RIGHT TO STOCK BUY) - ------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------- =========================================================================================================================
Explanation of Responses: /s/ Debra Bloy 01-27-03 - ------------------------------- ------------ **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. 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 space provided is insufficient, see Instruction 6 for procedures. 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. Page 3 of 3 -----END PRIVACY-ENHANCED MESSAGE-----