5 1 e-9486.txt FORM 5 FOR MICHAEL HERRON ------------------------------ 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* HERRON MICHAEL J. -------------------------------------------------------------------------------- (Last) (First) (Middle) 5050 NORTH 40th STREET, SUITE 200 -------------------------------------------------------------------------------- (Street) PHOENIX ARIZONA 850318 ------------------------------------------------------------------------------ (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) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) SECRETARY ------------------------------------ ================================================================================ 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) ------------------------------------------------------------------------------------------------------------------------- OFFICER STOCK $4.16 07-22-02 A 5,OOO 07-22-02 07-21-12 COMMON 5000 15,000 D OPTION (RIGHT TO STOCK BUY) ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- =========================================================================================================================
Explanation of Responses: /s/ Michael J. Herron 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