-----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, OcX82+qeC/C8PbJeCOdePXWBRg6JpXJJ5Xoqp/ho6gLtB8Z1VJ857CRxfkuhFygu 1GqJiBc+UyeZ5Ztqcb0FzA== 0001068238-99-000204.txt : 19991231 0001068238-99-000204.hdr.sgml : 19991231 ACCESSION NUMBER: 0001068238-99-000204 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991223 FILED AS OF DATE: 19991230 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MICROTEL INTERNATIONAL INC CENTRAL INDEX KEY: 0000854852 STANDARD INDUSTRIAL CLASSIFICATION: INSTRUMENTS FOR MEAS & TESTING OF ELECTRICITY & ELEC SIGNALS [3825] IRS NUMBER: 770226211 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 001-10346 FILM NUMBER: 99783655 BUSINESS ADDRESS: STREET 1: 4290 E BRICKELL ST STREET 2: STE 102 CITY: ONTARIO STATE: CA ZIP: 91761-1511 BUSINESS PHONE: 9094564321 MAIL ADDRESS: STREET 1: 4290 E BRICKELL STREET STREET 2: STE 102 CITY: ONTARIO STATE: CA ZIP: 91761-1511 FORMER COMPANY: FORMER CONFORMED NAME: CXR CORP DATE OF NAME CHANGE: 19920703 COMPANY DATA: COMPANY CONFORMED NAME: ORBIT II PARTNERS LP CENTRAL INDEX KEY: 0001098053 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] OWNER IRS NUMBER: 133448998 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O ORBIT II PARTNERS LP STREET 2: 2 RECTOR STREET 16TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10006 BUSINESS PHONE: 2122331340 MAIL ADDRESS: STREET 1: C/O ORBIT II PARTNERS LP STREET 2: 2 RECTOR STREET 16TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10006 3 1 FORM 3 ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0104 Expires: 9/30/1998 Estimated average burden hours per response ..... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 1. Name and Address of Reporting Person* Orbit II Partners, L.P. 2 Rector Street, 16th Floor New York, New York 10006 2. Date of Event Requiring Statement (Month/Day/Year) December 23, 1999 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) 4. Issuer Name and Ticker or Trading Symbol MicroTel International, Inc. (OTC.BB: "MCTL.OB") 5. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) 6. If Amendment, Date of Original (Month/Day/Year) 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 Beneficially Owned ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr.5) Common Stock 755,700(1) D Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v).
Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - - ---------------------------------------------------------------------------------------------------------------------------------- Warrant 12/23/99 12/23/02 Common Stock 172,500 $0.25 D Series A Preferred Stock 12/23/99 5/22/03(1) Common Stock 1,743,285 (1) D /s/ Alan S. MacKenzie, Jr. December 28, 1999 ___________________________ ----------------------- Alan S. MacKenzie, Jr. Date As a General Partner **Signature of Reporting Person ** 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 procedure. (1) Each share of Series A Preferred Stock is convertible into 50,530 shares of Common Stock prior to May 22, 2003. On May 22, 2003, the Issuer is required to redeem each outstanding share of Series A Preferred Stock for $11,500.00. Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, SEE Instruction 6 for procedure.
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